Provider Demographics
NPI:1235503665
Name:KOMINOS INTEGRATIVE CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:KOMINOS INTEGRATIVE CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:AKRIVE
Authorized Official - Last Name:KOMINOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-620-9398
Mailing Address - Street 1:107 MONMOUTH RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1021
Mailing Address - Country:US
Mailing Address - Phone:732-620-9398
Mailing Address - Fax:
Practice Address - Street 1:107 MONMOUTH RD STE 201
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1021
Practice Address - Country:US
Practice Address - Phone:732-620-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA4696500261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13365Medicare UPIN