Provider Demographics
NPI:1841638731
Name:RATNAYAKE, PANCHAKA (RN)
Entity type:Individual
Prefix:MR
First Name:PANCHAKA
Middle Name:
Last Name:RATNAYAKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 LABAU AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4243
Mailing Address - Country:US
Mailing Address - Phone:646-705-3104
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON ST
Practice Address - Street 2:SUITE 601
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4281
Practice Address - Country:US
Practice Address - Phone:516-933-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668830-1163W00000X
NJ26NR16657800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse