Provider Demographics
NPI:1275747578
Name:CECORA, RAYMOND N (PT DPT MS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:N
Last Name:CECORA
Suffix:
Gender:M
Credentials:PT DPT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-798-3789
Mailing Address - Fax:516-798-3589
Practice Address - Street 1:5500 MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-798-3789
Practice Address - Fax:516-798-3589
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q82761Medicare ID - Type UnspecifiedIND NUMBER
Q2W5J1Medicare ID - Type UnspecifiedGROUP