Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 037665 | CT |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 037655 | CT |
NPI | 1164429619 |
---|---|
Provider Name | Dr. Ignatius Komninakas |
First Address | Shelton, CT 06484-7622 |
Second Address | Shelton, CT 06484-7622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001376658 | (05) | CT |
G49666 | (02) |