Individual
MRS. LISA MARIE KOMNIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSC, ATC
Contact information
Practice address
100 NICHOLLS ROAD SPORTS COMPLEX G33, STONY BROOK, NY 11794-2325
(631) 632-7164
(631) 632-7210
Mailing address
155 W ROE BLVD, DANZI ATHLETIC CENTER, PATCHOGUE, NY 11772-2325
(631) 447-3330
(631) 447-3347
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000038-1
NY
Other
Enumeration date
02/17/2006
Last updated
09/10/2020
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