Provider Demographics
NPI:1649224171
Name:KOMISAR, ROBIN (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:KOMISAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FRASER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1428
Mailing Address - Country:US
Mailing Address - Phone:203-387-9066
Mailing Address - Fax:
Practice Address - Street 1:309 SEASIDE AVE
Practice Address - Street 2:SUITE201
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4625
Practice Address - Country:US
Practice Address - Phone:203-783-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered