Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA10372900 | NJ |
NPI | 1003203464 |
---|---|
Provider Name | Cynthia N Edirisuriya |
First Address | Bordentown, NJ 08505-2275 |
Second Address | Bordentown, NJ 08505-2275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 15/07/2021 |