Individual
DR. WATUTANTRIGE TAKSHAN DEALWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
223 N VAN DIEN AVE, RIDGEWOOD, NJ 07450-2726
(201) 447-8586
(201) 447-8491
Mailing address
71 BERKELY PLACE, ALPINE, NJ 07620
(201) 750-1907
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
25MA04286900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6358900
—
NJ
Enumeration date
05/19/2006
Last updated
11/15/2011
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