Provider Demographics
NPI:1013274141
Name:L.A.SAMARASINGHE, MD, PA
Entity Type:Organization
Organization Name:L.A.SAMARASINGHE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMARASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-666-4480
Mailing Address - Street 1:49 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3127
Mailing Address - Country:US
Mailing Address - Phone:201-666-4480
Mailing Address - Fax:201-666-7386
Practice Address - Street 1:49 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3127
Practice Address - Country:US
Practice Address - Phone:201-666-4480
Practice Address - Fax:201-666-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02652800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE70671Medicare UPIN