Provider Demographics
NPI:1780688192
Name:KOMINOS, VIVIAN AKRIVE (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:AKRIVE
Last Name:KOMINOS
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 1:901 W MAIN ST STE 205
Mailing Address - Street 2:CN 5050
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-866-0800
Mailing Address - Fax:732-866-0018
Practice Address - Street 1:901 W MAIN ST STE 205
Practice Address - Street 2:CN5050
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-866-0800
Practice Address - Fax:732-866-0018
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46965207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS068OtherOXFORD
NJ0043373OtherAETNA HMO
NJ0037042OtherGHI PPO
NJ1049711OtherHORIZON NJ HEALTH
NJ4093924OtherAETNA PPO
F07150OtherHEALTHNET
060058972OtherRR MEDICARE
NJE13365Medicare UPIN
NJ1049711OtherHORIZON NJ HEALTH