Provider Demographics
NPI:1891478277
Name:KOMAR, SAMANTHA KATHLEEN (LPN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATHLEEN
Last Name:KOMAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SPINDLER TER
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4416
Mailing Address - Country:US
Mailing Address - Phone:201-783-6202
Mailing Address - Fax:
Practice Address - Street 1:12 SPINDLER TER
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4416
Practice Address - Country:US
Practice Address - Phone:201-783-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP49508200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse