Provider Demographics
NPI:1104836766
Name:COMEAU, JOHN W (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:COMEAU
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 1:21944 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2127
Mailing Address - Country:US
Mailing Address - Phone:718-217-1099
Mailing Address - Fax:718-217-1098
Practice Address - Street 1:21944 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-2127
Practice Address - Country:US
Practice Address - Phone:718-217-1099
Practice Address - Fax:718-217-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06881Medicare ID - Type Unspecified