Provider Demographics
NPI:1811286222
Name:KOMENDYAK, VIRA (NP)
Entity type:Individual
Prefix:
First Name:VIRA
Middle Name:
Last Name:KOMENDYAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 HARING ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1821
Mailing Address - Country:US
Mailing Address - Phone:347-564-5284
Mailing Address - Fax:
Practice Address - Street 1:2455 HARING ST APT 1H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1821
Practice Address - Country:US
Practice Address - Phone:347-564-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628539163W00000X
NYF309299-01363LG0600X
NYF405618-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology