Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102036958 | VA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DOS1022 | HI |
NPI | 1043385370 |
---|---|
Provider Name | Dr. Harold Kornylak |
First Address | Virginia Beach, VA 23451-3760 |
Second Address | Virginia Beach, VA 23451-3760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26561 | (02) | VA |