Basic Information
| Provider Information | |||||||||
| NPI: | 1700468196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIRATHEEPAN | ||||||||
| FirstName: | PAVATHARANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MBBS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SATHANANTHANAYAGAM | ||||||||
| OtherFirstName: | PAVATHARANI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 355, BARD AVENUE, | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, VILLA BLDG, 1ST FLOOR. | ||||||||
| City: | STATEN ISLAND. | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188182419 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 355 BARD AVE | ||||||||
| Address2: | DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLR. | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103101699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188182419 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2021 | ||||||||
| LastUpdateDate: | 04/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.