MEDICARE: TIMOTHY JAYASUNDERA, M.D. P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1225049638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY JAYASUNDERA, M.D. P.C

Provider Business Mailing Address
First Line	:	515 E 72ND ST
Second Line	:	APT 24C
City	:	NEW YORK
State	:	NY
Zip	:	10021-4032
Country	:	US
Telephone Number	:	917-214-0084
Fax Number	:	917-536-9945

Provider Business Practice Location Address
First Line	:	5402 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2436
Country	:	US
Telephone Number	:	718-763-6666
Fax Number	:	718-251-5636

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY G JAYASUNDERA
Credential	:	M.D.
Telephone Number	:	917-214-0084

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/13/2016

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