Provider Demographics
NPI:1962656652
Name:WANAGOSIT, SUREE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SUREE
Middle Name:
Last Name:WANAGOSIT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HAWKSHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4967
Mailing Address - Country:US
Mailing Address - Phone:732-873-1787
Mailing Address - Fax:732-873-7660
Practice Address - Street 1:404 HAWKSHEAD WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4967
Practice Address - Country:US
Practice Address - Phone:732-873-1787
Practice Address - Fax:732-873-7660
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022760-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics