Provider Demographics
NPI:1366506461
Name:RAYMOND N CECORA PT PC
Entity Type:Organization
Organization Name:RAYMOND N CECORA PT PC
Other - Org Name:PARK PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:N
Authorized Official - Last Name:CECORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT MS
Authorized Official - Phone:516-798-3789
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q2W5J1Medicare ID - Type Unspecified