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General NPI Number Information
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NPI Number | 1831646009
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Entity Type | Organization
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Legal Business Name | TIMOTHY G JAYASUNDERA MD PC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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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 | PO BOX 287125
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City | NEW YORK
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State | NY
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Zip | 10128-0019
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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 | OFFICE MANAGER
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Name | JEANETTE RUIZ
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Credential |
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Telephone | 718-763-6666
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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 | 215825-1
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License Number State | NY
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