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General NPI Number Information
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NPI Number | 1235503665
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Entity Type | Organization
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Legal Business Name | KOMINOS INTEGRATIVE CARDIOLOGY, LLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 107 MONMOUTH RD STE 201
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1021
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Country | US
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Telephone | 732-620-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 107 MONMOUTH RD STE 201
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1021
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Country | US
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Telephone | 732-620-9398
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Fax |
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Authorized Official
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Title or Position | OWNER/CARDIOLOGIST
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Name | DR. VIVIAN AKRIVE KOMINOS
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Credential | MD
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Telephone | 732-620-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MA4696500
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License Number State | NJ
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