Healthcare Provider Details

I. General information

NPI: 1154583458
Provider Name (Legal Business Name): ATHULA GUNASEKARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E 101ST ST APT 5A
NEW YORK NY
10029-6530
US

IV. Provider business mailing address

3 E 101ST ST APT 5A
NEW YORK NY
10029-6530
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4029
  • Fax: 212-876-1493
Mailing address:
  • Phone: 212-241-4029
  • Fax: 212-876-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberP62129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: