Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA02688200 | NJ |
NPI | 1013951227 |
---|---|
Provider Name | Sena Sumathisena |
First Address | Browns Mills, NJ 08015-1705 |
Second Address | Browns Mills, NJ 08015-1705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 12/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0467502 | (05) | NJ |
C63006 | (02) | NJ |