Healthcare Provider Details

I. General information

NPI: 1871984922
Provider Name (Legal Business Name): ARNE KOMAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5392 SPRINGVIEW DR
FAYETTEVILLE NY
13066-9678
US

IV. Provider business mailing address

5392 SPRINGVIEW DR
FAYETTEVILLE NY
13066-9678
US

V. Phone/Fax

Practice location:
  • Phone: 315-637-2561
  • Fax:
Mailing address:
  • Phone: 315-637-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberR031943-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: