Lisa Marie Komnik, MSC, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

000038-1 Issued in NY

Practice address

100 Nicholls Road Sports Complex G33
Stony Brook, NY 11794-2325

Phone

(631) 632-7164

Fax

(631) 632-7210

NPI assigned

Feb 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1881669505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 W ROE BLVD",
            "address_2": "DANZI ATHLETIC CENTER",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722325",
            "telephone_number": "631-447-3330",
            "fax_number": "631-447-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICHOLLS ROAD SPORTS COMPLEX G33",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117942325",
            "telephone_number": "631-632-7164",
            "fax_number": "631-632-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMNIK",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSC, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "000038-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Kogan, DO
• Nancy Koh, NP-C
• Sara Kohler, DO
• Angela Amalia Kokkosis, MD
• Michelle Kolakowski
• Otar Koniashvili, M.D.
• Farrukh Mansoor Koraishy, MD, PHD
• Seth Korbin, MD
• Chaitali Korgaonkar-Cherala, MD
• Nicholas Daniel Korkosz, DO

• Athletic Trainer in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.