MEDICARE: MR. YEVGENY KOMM NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	308716	NY

General Provider Information

NPI Number	:	1558856211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YEVGENY KOMM NP

Provider Business Mailing Address
First Line	:	2388 OCEAN AVE STE MO
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3585
Country	:	US
Telephone Number	:	929-382-4876
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 LIVINGSTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5811
Country	:	US
Telephone Number	:	718-522-3399
Fax Number	:	718-522-1888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	08/30/2024

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