Provider Demographics
NPI:1114976230
Name:KOMOTAR, ANA MIGUEL (MD)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:MIGUEL
Last Name:KOMOTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 GORGE ROAD
Mailing Address - Street 2:SUITE 16 J
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-941-6159
Mailing Address - Fax:201-941-5296
Practice Address - Street 1:10 HURON AVE
Practice Address - Street 2:SUITE 1P
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-963-8203
Practice Address - Fax:201-963-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA030295002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0392308Medicaid
441891Medicare ID - Type Unspecified
C54565Medicare UPIN