Individual
GAYAN SAMPATH WIJEWA HEWA WICRAMA ARACHCHILAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13938 87TH AVE, BRIARWOOD, NY 11435-3018
(315) 244-4516
Mailing address
139-38 87TH AVENUE, BRAIRWOOD, NY 11435
(315) 244-4516
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
009972-1
NY
Other
Enumeration date
08/24/2015
Last updated
08/24/2015
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