Healthcare Provider Details

I. General information

NPI: 1043385370
Provider Name (Legal Business Name): HAROLD KORNYLAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 E BAY SHORE DR
VIRGINIA BEACH VA
23451-3760
US

IV. Provider business mailing address

1432 E BAY SHORE DR
VIRGINIA BEACH VA
23451-3760
US

V. Phone/Fax

Practice location:
  • Phone: 757-491-3294
  • Fax: 480-275-3481
Mailing address:
  • Phone: 757-491-3294
  • Fax: 480-275-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0102036958
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDOS1022
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: