Physician Compare National (NPI:1639331861)

HEALTHCARE PROVIDER: SUSANTHI GUNADASA MD, MBBS

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639331861
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143467456
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20131101001530
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GUNADASA
	Individual professional last name
Provider First Name	SUSANTHI
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1 W RIDGEWOOD AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 203
	Group Practice or individual's line 2 address
City	PARAMUS
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	076522359
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	310001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HACKENSACK UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	310008
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HOLY NAME MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	310012
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	310108
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	JFK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y