| Sujatha H Desilva | |
|
141 Pike St Port Jervis NY 12771-1807 | |
| (845) 856-4002 | |
| (845) 856-4002 |
| Full Name | Sujatha H Desilva |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 141 Pike St, Port Jervis, New York |
| Authorized Official Name and Position | Sujatha H Desilva (DENTIST) |
| Authorized Official Contact | 18458564002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sujatha H Desilva 141 Pike St Port Jervis NY 12771-1807 Ph: (845) 856-4002 | Sujatha H Desilva 141 Pike St Port Jervis NY 12771-1807 Ph: (845) 856-4002 |
| NPI Number | 1265696058 |
|---|---|
| Provider Enumeration Date | 07/11/2008 |
| Last Update Date | 07/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265696058 | NPI | - | NPPES |
| 0946341 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 039885 (New York) | Primary |
News Archive
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› Verified 8 days ago
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