Provider Demographics
NPI:1881669505
Name:KOMNIK, LISA MARIE (MSC, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:KOMNIK
Suffix:
Gender:F
Credentials:MSC, ATC
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Mailing Address - Street 1:155 W ROE BLVD
Mailing Address - Street 2:DANZI ATHLETIC CENTER
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2325
Mailing Address - Country:US
Mailing Address - Phone:631-447-3330
Mailing Address - Fax:631-447-3347
Practice Address - Street 1:100 NICHOLLS ROAD SPORTS COMPLEX G33
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2325
Practice Address - Country:US
Practice Address - Phone:631-632-7164
Practice Address - Fax:631-632-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-09-10
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Provider Licenses
StateLicense IDTaxonomies
NY000038-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer