1073641189 NPI number — MR. RAYMOND J POTKAY MA CCC SPL YS00372

Table of content: MR. RAYMOND J POTKAY MA CCC SPL YS00372 (NPI 1073641189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073641189 NPI number — MR. RAYMOND J POTKAY MA CCC SPL YS00372

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTKAY
Provider First Name:
RAYMOND
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SPL YS00372
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073641189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 PLAZA PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABSECON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-641-4416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOLY REDEEMER HOME HEALTH
Provider Second Line Business Practice Location Address:
6727 DELILAH RD
Provider Business Practice Location Address City Name:
EGG HARBOR TSWHP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-625-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  YS00372 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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