Provider Demographics
NPI:1063614618
Name:COMITALE, LANEY RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LANEY
Middle Name:RAE
Last Name:COMITALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LANEY
Other - Middle Name:RAE
Other - Last Name:WINKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2215 BURDETT AVE
Mailing Address - Street 2:EMERGENCY ROOM- SAMARITON HOSPITAL
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-271-3450
Mailing Address - Fax:518-271-3131
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-271-3450
Practice Address - Fax:518-271-3131
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011921363A00000X
PENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant