Provider Demographics
NPI:1407370703
Name:KOMARGODSKI, OLGA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KOMARGODSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1388
Mailing Address - Country:US
Mailing Address - Phone:833-660-7246
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF MEDICINE HSC LEVEL 16 STONY
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY315058012081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program