Provider Demographics
NPI:1083444830
Name:KARUNANAYAKE, KARUNANAYAKE
Entity type:Individual
Prefix:
First Name:KARUNANAYAKE
Middle Name:
Last Name:KARUNANAYAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIMA
Other - Middle Name:
Other - Last Name:KARUNANAYAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:160 PASSAIC AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1130
Mailing Address - Country:US
Mailing Address - Phone:401-346-8001
Mailing Address - Fax:
Practice Address - Street 1:160 PASSAIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1130
Practice Address - Country:US
Practice Address - Phone:201-467-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00731300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist