1609801927 NPI number — MS. ISABEL K KOMORNICKI NP

Table of content: MS. ISABEL K KOMORNICKI NP (NPI 1609801927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609801927 NPI number — MS. ISABEL K KOMORNICKI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOMORNICKI
Provider First Name:
ISABEL
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609801927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8000 DEPT 313
Provider Second Line Business Mailing Address:
UNIVERSITY AT BUFFALO SURGEONS, INC.
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14267-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-898-5227
Provider Business Mailing Address Fax Number:
716-898-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGH ST
Provider Second Line Business Practice Location Address:
DEPT. OF SURGERY
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-887-4221
Provider Business Practice Location Address Fax Number:
716-887-4220
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  F302337 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02504745 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: RB4653 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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