Provider Demographics
NPI:1154841633
Name:KOMENDA, JOSEPH GEORGE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GEORGE
Last Name:KOMENDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1845
Mailing Address - Country:US
Mailing Address - Phone:716-422-2002
Mailing Address - Fax:716-893-0128
Practice Address - Street 1:1500 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1845
Practice Address - Country:US
Practice Address - Phone:716-422-2002
Practice Address - Fax:716-893-0128
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist