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General NPI Number Information
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NPI Number | 1225049638
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Entity Type | Organization
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Legal Business Name | TIMOTHY JAYASUNDERA, M.D. P.C
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 5402 FLATLANDS AVE
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City | BROOKLYN
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State | NY
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Zip | 11234-2436
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Country | US
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Telephone | 718-763-6666
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Fax | 718-251-5636
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Provider Business Mailing Address
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Address Line | 515 E 72ND ST APT 24C
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City | NEW YORK
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State | NY
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Zip | 10021-4032
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Country | US
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Telephone | 917-214-0084
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Fax | 917-536-9945
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY G JAYASUNDERA
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Credential | M.D.
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Telephone | 917-214-0084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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