Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 000044 | NY |
NPI | 1134385016 |
---|---|
Provider Name | Janatha Withanachchi |
First Address | Bronx, NY 10467-2625 |
Second Address | Bronx, NY 10467-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 31/07/2008 |