Provider Demographics
NPI:1144356189
Name:KNIZEK, RAYMOND D (L, ATC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:D
Last Name:KNIZEK
Suffix:
Gender:M
Credentials:L, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 BLISS RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2047
Mailing Address - Country:US
Mailing Address - Phone:518-882-9141
Mailing Address - Fax:
Practice Address - Street 1:56 DUPLAINVILLE RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9020
Practice Address - Country:US
Practice Address - Phone:518-581-4487
Practice Address - Fax:518-581-4904
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000676-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000676-1OtherATC LICENSE NUMBER