Provider Demographics
NPI:1023355542
Name:LUKOSE, RAYMON (DPT)
Entity type:Individual
Prefix:
First Name:RAYMON
Middle Name:
Last Name:LUKOSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 W BOSTON POST RD
Mailing Address - Street 2:C/O EQUINOX
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3329
Mailing Address - Country:US
Mailing Address - Phone:914-381-0203
Mailing Address - Fax:914-381-0207
Practice Address - Street 1:2142 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4142
Practice Address - Country:US
Practice Address - Phone:718-767-0610
Practice Address - Fax:516-750-9076
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist