MEDICARE: DR. SELVANAYAGAM NIRANJAN 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	207RC0000X	Cardiovascular Disease Physician	222439	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942275375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SELVANAYAGAM NIRANJAN MD

Provider Business Mailing Address
First Line	:	55 NETHERWOOD DR
Second Line	:
City	:	ALBERTSON
State	:	NY
Zip	:	11507-1310
Country	:	US
Telephone Number	:	718-616-3779
Fax Number	:	718-616-3797

Provider Business Practice Location Address
First Line	:	2601 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7745
Country	:	US
Telephone Number	:	718-616-3779
Fax Number	:	718-616-3797

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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