Provider Demographics
NPI:1073641189
Name:POTKAY, RAYMOND J (MA CCC SPL YS00372)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:POTKAY
Suffix:
Gender:M
Credentials:MA CCC SPL YS00372
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 PLAZA PLACE
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-641-4416
Mailing Address - Fax:
Practice Address - Street 1:HOLY REDEEMER HOME HEALTH
Practice Address - Street 2:6727 DELILAH RD
Practice Address - City:EGG HARBOR TSWHP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-625-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS00372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist