Jayatilaka, Channa D
Jayatilaka, Channa D is an individual health care provider with primary practice located at 109 Carleton Ave , Central Islip NY 11722-3616. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Jayatilaka, Channa D can be contacted via phone (631) 348-2500.Contact Information
Primary practice address
109 Carleton Ave
Central Islip NY 11722-3616
Phone: (631) 348-2500
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 048111 | New York |
Profile Details
| NPI number | 1063612810 |
|---|---|
| LBN Legal business name | Jayatilaka, Channa D |
| Credentials | DDS, PH.D |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2007 |
| Last updated | Jul 19th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063612810 | NPPES |
| New York | MEDICAID | 02145971 |
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