Provider Demographics
NPI:1851711998
Name:KOMARNITSKY, IGOR (RN)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:KOMARNITSKY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 RIDGE BLVD APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2930
Mailing Address - Country:US
Mailing Address - Phone:347-421-7774
Mailing Address - Fax:
Practice Address - Street 1:7501 RIDGE BLVD AP 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:347-421-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574398163W00000X
FLRN9378976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse