Provider Demographics
NPI:1316163025
Name:KOMAROFF, ARIANA ROSE (NP)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:ROSE
Last Name:KOMAROFF
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ARIANA
Other - Middle Name:JANE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 HARRISON AVE STE G105-2
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3145
Mailing Address - Country:US
Mailing Address - Phone:914-412-6335
Mailing Address - Fax:914-357-2727
Practice Address - Street 1:1600 HARRISON AVE STE G105-2
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-412-6335
Practice Address - Fax:914-357-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512951163WL0100X
CT006193363LF0000X
NY334364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008062989Medicaid