Healthcare Provider Details

I. General information

NPI: 1982109740
Provider Name (Legal Business Name): HARAN SIVAKUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
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: 956-394-1214
Mailing address:
  • Phone: 917-284-8973
  • Fax: 956-394-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number312837
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number312837
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number312837
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA163513
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number312837
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA163513
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA163513
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberA163513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: