Provider Demographics
NPI:1922141381
Name:KOMETZ-ROCK, SMADAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SMADAR
Middle Name:
Last Name:KOMETZ-ROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BROAD ST
Mailing Address - Street 2:UNIT C 4
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4751
Mailing Address - Country:US
Mailing Address - Phone:203-877-1766
Mailing Address - Fax:203-877-8053
Practice Address - Street 1:203 BROAD ST
Practice Address - Street 2:UNIT C 4
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4751
Practice Address - Country:US
Practice Address - Phone:203-877-1766
Practice Address - Fax:203-877-8053
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0383962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT260004076Medicare ID - Type Unspecified