Provider Demographics
NPI:1790772663
Name:COMASSAR, JAY ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARTHUR
Last Name:COMASSAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:656 NO. WELLWOOD AVE.
Mailing Address - Street 2:STE. 208B
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-957-7277
Mailing Address - Fax:631-226-0900
Practice Address - Street 1:656 NO. WELLWOOD AVE.
Practice Address - Street 2:STE. 208B
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-957-7277
Practice Address - Fax:631-226-0900
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3308213E00000X
NYN003308213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007866635Medicaid
P37371Medicare ID - Type Unspecified
NY007866635Medicaid