MEDICARE: DR. VIVIAN AKRIVE KOMINOS M.D.

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	207RC0000X	Cardiovascular Disease Physician	MA46965	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	060058972	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MS068	OTHER		OXFORD
2	0043373	OTHER	NJ	AETNA HMO
3	0037042	OTHER	NJ	GHI PPO
4	1049711	OTHER	NJ	HORIZON NJ HEALTH
5	4093924	OTHER	NJ	AETNA PPO
6	F07150	OTHER		HEALTHNET

General Provider Information

NPI Number	:	1780688192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN AKRIVE KOMINOS M.D.

Provider Business Mailing Address
First Line	:	901 W MAIN ST STE 205
Second Line	:	CN 5050
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-866-0018

Provider Business Practice Location Address
First Line	:	901 W MAIN ST STE 205
Second Line	:	CN5050
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-866-0018

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/29/2011

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