Provider Demographics
NPI:1003203464
Name:EDIRISURIYA, CYNTHIA N (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:N
Last Name:EDIRISURIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 K JOHNSON BLVD. N.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2275
Mailing Address - Country:US
Mailing Address - Phone:609-528-8884
Mailing Address - Fax:609-528-8886
Practice Address - Street 1:100 K JOHNSON BLVD. N.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2275
Practice Address - Country:US
Practice Address - Phone:609-528-8884
Practice Address - Fax:609-528-8886
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10372900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program