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General NPI Number Information
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NPI Number | 1578724019
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Entity Type | Organization
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Legal Business Name | PRASANNA C WICKREMESINGHE MD PC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 481 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2103
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Country | US
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Telephone | 718-448-0865
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Fax | 718-816-8065
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Provider Business Mailing Address
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Address Line | 481 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2103
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Country | US
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Telephone | 718-448-0865
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Fax | 718-816-8065
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PRASANNA C WICKREMESINGHE
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Credential | MD
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Telephone | 718-448-0865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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