Active NPI
Channa D Jayatilaka, DDS, PH.D
- Dentist
- Central Islip, NY
National Provider Identifier
1063612810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 048111
- Practice address
- 109 Carleton Ave
Central Islip, NY 11722-3616 - Phone
- (631) 348-2500
- NPI assigned
- Jul 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 048111 | NY | Primary |
Addresses
Primary practice location
109 Carleton Ave
Central Islip, NY 11722-3616
Mailing address
3 Belwyn LN
South Setauket, NY 11720-1408
Phone (631) 732-4396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02145971 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048111 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kirshenbaum Peruso Kautman LLP | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Carleton Ave Family Dental
- Dentist
- Central Islip, NY
- NPI 1720160690
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184803200000",
"number": "1063612810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 BELWYN LN",
"city": "SOUTH SETAUKET",
"state": "NY",
"postal_code": "117201408",
"telephone_number": "631-732-4396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 CARLETON AVE",
"city": "CENTRAL ISLIP",
"state": "NY",
"postal_code": "117223616",
"telephone_number": "631-348-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAYATILAKA",
"first_name": "CHANNA",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS, PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2007-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "048111",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02145971",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Central Islip, NY
- Eunique Jackson, L.P.N
- Jaclyn a. Farino, NP in Adult Health & Psychiatry, PLLC
- Nichole Michelle Jacobsen, RN
- Jamelee Shakira James
- Jaritza Elizabeth Jara
- Richard Jean-Baptiste, LPN
- Samantha Jean-Baptiste
- Natacha Jean
- Jewish Board of Family & Children'S Services (The Jewish Board Suffolk ACT Team)
- Jewlz Helpimg Hands Home Health Agency (Jewelz Helping Hands Home Health Agency)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.