Individual provider Active NPI

Komal Dold

  • Family Nurse Practitioner
  • Bethpage, NY
National Provider Identifier
1093251373
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
348241 Issued in NY
Practice address
4045 Hempstead Tpke
Bethpage, NY 11714-5611
Phone
(516) 731-7770
NPI assigned
Jan 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 718609-1 NY
Family Nurse Practitioner 363LF0000X 348241 NY Primary

Addresses

Primary practice location

4045 Hempstead Tpke
Bethpage, NY 11714-5611

Mailing address

4045 Hempstead Tpke
Bethpage, NY 11714-5611
Phone (516) 731-7770

Other practice location 1

1500 NY-112 Building 2
Suite B
Port Jefferson Station, NY 11776
Phone (631) 978-7633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210924002017 NY Practitioner - Nurse Practitioner 2264839893 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1750

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-0580

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
718609-1NYMDRegistered Nurse
348241NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince May 18, 2022 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince May 18, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

200 Motor Pkwy
Ste C16
Hauppauge, NY 11788
Phone (631) 638-4933

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

1500 Route 112
Ste B
Port Jefferson Station, NY 11776
Phone (631) 343-4184

75 N Country Rd
Ste 201
Prt Jefferson, NY 11777
Phone (631) 686-2575

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

47 Commerce Ave
Ste 1
Riverhead, NY 11901
Phone (631) 978-7633

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1093251373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145611",
            "telephone_number": "516-731-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145611",
            "telephone_number": "516-731-7770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 NY-112 Building 2",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson Station",
            "state": "NY",
            "postal_code": "11776",
            "country_code": "US",
            "telephone_number": "631-978-7633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLD",
        "first_name": "KOMAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-11",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "718609-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

Verify at the official NPI Registry.