Individual
DR. KANISTA MENIKE BASNAYAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
365 E MAIN ST, SOUTH BROOKHAVEN HEALTH CENTER WEST, PATCHOGUE, NY 11772-3145
(631) 854-1281
Mailing address
3 ESPLANADE DR, EAST PATCHOGUE, NY 11772-7905
(631) 758-6773
(631) 758-6773
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
189498
NY
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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