Basic Information
| Provider Information | |||||||||
| NPI: | 1851705628 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | UBAYAWARDENA | ||||||||
| FirstName: | RESIKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HIGHWAY SOUTH | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859221304 | ||||||||
| FaxNumber: | 5859221399 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST, STE 5000 | ||||||||
| Address2: | GENESEE INTERNAL MEDICINE AT ALEXANDER PARK | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228003 | ||||||||
| FaxNumber: | 5859228195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 289710 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.