Provider Demographics
NPI:1881705291
Name:DUFRESNE, JOHN MICHAEL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:DUFRESNE
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 1:12 VILLAGE STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-562-8140
Mailing Address - Fax:203-562-7265
Practice Address - Street 1:12 VILLAGE STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-562-8140
Practice Address - Fax:203-562-7265
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37401OtherCIGNA
897715OtherAETNA
A531345OtherOXFORD
0V1735OtherHEALTHNET
080002017CT01OtherBCBS