Healthcare Provider Details

I. General information

NPI: 1114864451
Provider Name (Legal Business Name): HARISH DATTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 JEFFERSON AVE
SCRANTON PA
18510-2439
US

IV. Provider business mailing address

315 JEFFERSON AVE
SCRANTON PA
18510-2439
US

V. Phone/Fax

Practice location:
  • Phone: 516-233-0647
  • Fax:
Mailing address:
  • Phone: 516-233-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN770530
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: