Provider Demographics
NPI:1407801798
Name:CLERK, HARNATH BALENDRA (MD)
Entity Type:Individual
Prefix:
First Name:HARNATH
Middle Name:BALENDRA
Last Name:CLERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108
Mailing Address - Country:US
Mailing Address - Phone:716-778-7237
Mailing Address - Fax:716-778-6074
Practice Address - Street 1:2610 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108
Practice Address - Country:US
Practice Address - Phone:716-778-7237
Practice Address - Fax:716-778-6074
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01461545Medicaid
F56745Medicare UPIN
NY01461545Medicaid