Provider Demographics
NPI:1831485721
Name:CO, JOHN PATRICK
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:CO
Suffix:
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 1:656 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1836
Mailing Address - Country:US
Mailing Address - Phone:716-883-0515
Mailing Address - Fax:716-883-8764
Practice Address - Street 1:656 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1836
Practice Address - Country:US
Practice Address - Phone:716-883-0515
Practice Address - Fax:716-883-8764
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033673208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation