Provider Demographics
NPI:1063263499
Name:KANAGALINGAM, SUTHASENTHURAN (MD)
Entity type:Individual
Prefix:
First Name:SUTHASENTHURAN
Middle Name:
Last Name:KANAGALINGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVENUE 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:646-226-5213
Mailing Address - Fax:
Practice Address - Street 1:36-11 21ST STREET
Practice Address - Street 2:
Practice Address - City:LONG ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:646-226-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-11-05
Deactivation Date:2024-11-04
Deactivation Code:
Reactivation Date:2024-11-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program