Healthcare Provider Details

I. General information

NPI: 1811286222
Provider Name (Legal Business Name): VIRA KOMENDYAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 347-564-5284
  • Fax:
Mailing address:
  • Phone: 347-564-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number628539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF309299-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405618-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: