Healthcare Provider Details

I. General information

NPI: 1700594348
Provider Name (Legal Business Name): SIVAKUMAR MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WALL ST STE 475
NEW YORK NY
10005-4301
US

IV. Provider business mailing address

99 WALL ST STE 475
NEW YORK NY
10005-4301
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-8973
  • Fax:
Mailing address:
  • Phone: 917-284-8973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARAN SIVAKUMAR
Title or Position: OWNER
Credential:
Phone: 408-636-6058