# GERIATRICS AND INTERNAL MEDICINE ASSOCIATES OF NORTHEAST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952769960
- **Authorized official:** SUSANTHI GUNADASA MD, MBBS (OWNER)
- **Authorized official phone:** (347) 308-4561

## Contact information

- **Practice address:** 1 W RIDGEWOOD AVE, SUITE 203, PARAMUS, NJ 07652-2359
- **Practice address phone:** (347) 308-4561
- **Mailing address:** 1 W RIDGEWOOD AVE, SUITE 203, PARAMUS, NJ 07652-2359
- **Mailing address phone:** (347) 308-4561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 02/04/2016
- **Last updated:** 02/04/2016