Provider Demographics
NPI:1659796738
Name:VYJANTHANATH ROHAN GUNASINGHAM, M.D.
Entity Type:Organization
Organization Name:VYJANTHANATH ROHAN GUNASINGHAM, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:PYTLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-208-4766
Mailing Address - Street 1:725 ORCHARD PARK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3352
Mailing Address - Country:US
Mailing Address - Phone:716-748-6002
Mailing Address - Fax:716-748-6002
Practice Address - Street 1:725 ORCHARD PARK RD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3352
Practice Address - Country:US
Practice Address - Phone:716-748-6002
Practice Address - Fax:716-748-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249369-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03030384Medicaid