Healthcare Provider Details

I. General information

NPI: 1043149081
Provider Name (Legal Business Name): HARIVANSH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N PERSHING ST
ENERGY IL
62933-3591
US

IV. Provider business mailing address

PO BOX 759
ENERGY IL
62933-0759
US

V. Phone/Fax

Practice location:
  • Phone: 914-343-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: PRIYANKA PATEL
Title or Position: DENTIST
Credential: DDS
Phone: 914-343-3312