MEDICARE: DR. SANATH DHARMASENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	254605	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25MA10715000	OTHER	NJ	LICENSE

General Provider Information

NPI Number	:	1730347949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANATH DHARMASENA MD

Provider Business Mailing Address
First Line	:	1290 FOREST HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6368
Country	:	US
Telephone Number	:	845-514-4278
Fax Number	:	718-442-8451

Provider Business Practice Location Address
First Line	:	11 RALPH PL STE 105
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4405
Country	:	US
Telephone Number	:	845-514-4278
Fax Number	:	888-501-6619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	12/12/2022

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