Provider Demographics
NPI:1265506026
Name:MARIADASON, SARATHAMANI (MD)
Entity Type:Individual
Prefix:
First Name:SARATHAMANI
Middle Name:
Last Name:MARIADASON
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 1:401 E 86TH ST
Mailing Address - Street 2:APT # 5J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6403
Mailing Address - Country:US
Mailing Address - Phone:212-600-0455
Mailing Address - Fax:212-600-4035
Practice Address - Street 1:8620 18TH AVE
Practice Address - Street 2:BENSONHURST OUTPATIENT CLINIC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3702
Practice Address - Country:US
Practice Address - Phone:718-256-8818
Practice Address - Fax:718-234-2314
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171112-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF37289Medicare UPIN
NY84K763Medicare ID - Type Unspecified