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Organization
SUJATHA H DESILVA
Active
Organization
SUJATHA H DESILVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUJATHA H DESILVA D.D.S (DENTIST)
18458564002
Entity
Organization
Contact information
Practice address
141 PIKE ST, PORT JERVIS, NY 12771-1807
(845) 856-4002
(845) 856-4002
Mailing address
141 PIKE ST, PORT JERVIS, NY 12771-1807
(845) 856-4002
(845) 856-4002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
039885
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0946341
—
NY
Enumeration date
07/11/2008
Last updated
07/11/2008
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