Provider Demographics
NPI:1316662273
Name:KOZIRESKI, RAYMOND EDWARD JR
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:KOZIRESKI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GLENMERE COVE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6059
Mailing Address - Country:US
Mailing Address - Phone:845-291-4740
Mailing Address - Fax:
Practice Address - Street 1:2 GLENMERE COVE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6059
Practice Address - Country:US
Practice Address - Phone:845-291-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant