Provider Demographics
NPI:1275301004
Name:KOMAROV, NINA (ND)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:KOMAROV
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 REARDON RD EXT
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8610
Mailing Address - Country:US
Mailing Address - Phone:804-300-2712
Mailing Address - Fax:
Practice Address - Street 1:6 REARDON RD EXT
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8610
Practice Address - Country:US
Practice Address - Phone:804-300-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath