Healthcare Provider Details

I. General information

NPI: 1043456841
Provider Name (Legal Business Name): DHAYAPARAN MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14203 60TH AVE
FLUSHING NY
11355-5301
US

IV. Provider business mailing address

14203 60TH AVE
FLUSHING NY
11355-5301
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-0533
  • Fax: 718-353-0506
Mailing address:
  • Phone: 718-353-0533
  • Fax: 718-353-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239481
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number239481
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01822357
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. SELLATHURAI KANAGARAJAH DHAYAPARAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-570-6976