NPIMap

Organization Active NPI

Sujatha H Desilva

  • General Practice Dentistry
  • Port Jervis, NY
National Provider Identifier
1265696058
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
039885 Issued in NY
Legal business name
SUJATHA H DESILVA
Practice address
141 Pike St
Port Jervis, NY 12771-1807
Phone
(845) 856-4002
Fax
(845) 856-4002
NPI assigned
Jul 11, 2008
Last updated
Jul 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sujatha H Desilva, D.D.SNPI 1639251846
Title
Dentist
Phone
(845) 856-4002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 039885 NY Primary

Addresses

Primary practice location

141 Pike St
Port Jervis, NY 12771-1807

Mailing address

141 Pike St
Port Jervis, NY 12771-1807
Phone (845) 856-4002

Other identifiers 1

IdentifierTypeStateIssuer
0946341MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Sujatha H de Silva DDS PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

141 Pike St
Port Jervis, NY 12771
Phone (845) 856-4002

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1265696058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 PIKE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711807",
            "telephone_number": "845-856-4002",
            "fax_number": "845-856-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 PIKE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711807",
            "telephone_number": "845-856-4002",
            "fax_number": "845-856-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUJATHA H DESILVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "DESILVA",
        "authorized_official_first_name": "SUJATHA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "18458564002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0946341",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jervis, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.