Healthcare Provider Details

I. General information

NPI: 1124057807
Provider Name (Legal Business Name): HALUBAI G YEKANATH MD,FACC,FRCP(UK),
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD V A HOSPITAL
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

PO BOX 585
CASTLE POINT NY
12511-0585
US

V. Phone/Fax

Practice location:
  • Phone: 845-440-6830
  • Fax:
Mailing address:
  • Phone: 845-440-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11974
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: