| NPI | 1952769960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANTHI GUNADASA Owner 347-308-4561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2016-02-04 |