Healthcare Provider Details

I. General information

NPI: 1609801927
Provider Name (Legal Business Name): ISABEL K KOMORNICKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST DEPT. OF SURGERY
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

PO BOX 8000 DEPT 313 UNIVERSITY AT BUFFALO SURGEONS, INC.
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 716-887-4221
  • Fax: 716-887-4220
Mailing address:
  • Phone: 716-898-5227
  • Fax: 716-898-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: