Healthcare Provider Details

I. General information

NPI: 1245203165
Provider Name (Legal Business Name): HARSHAN I WEERACKODY MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 LITTLE BRITAIN RD
NEW WINDSOR NY
12553
US

IV. Provider business mailing address

1 COLUMBIA ST SUITE 200
POUGHKEEPSIE NY
12601-3923
US

V. Phone/Fax

Practice location:
  • Phone: 845-567-1800
  • Fax: 845-567-9069
Mailing address:
  • Phone: 845-473-1188
  • Fax: 845-473-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207732
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number207732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: