Basic Information
| Provider Information | |||||||||
| NPI: | 1265506026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIADASON | ||||||||
| FirstName: | SARATHAMANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 E 86TH ST | ||||||||
| Address2: | APT # 5J | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100286403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126000455 | ||||||||
| FaxNumber: | 2126004035 | ||||||||
| Practice Location | |||||||||
| Address1: | 8620 18TH AVE | ||||||||
| Address2: | BENSONHURST OUTPATIENT CLINIC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112143702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182568818 | ||||||||
| FaxNumber: | 7182342314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 171112-1 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.