Healthcare Provider Details

I. General information

NPI: 1104186055
Provider Name (Legal Business Name): IRYNA KOMENDYAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OCEAN PKWY STE L1
BROOKLYN NY
11235-8344
US

IV. Provider business mailing address

2455 HARING ST APT 1H
BROOKLYN NY
11235-1821
US

V. Phone/Fax

Practice location:
  • Phone: 929-703-2772
  • Fax:
Mailing address:
  • Phone: 917-741-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number635483-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number347498
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347498-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: