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Organization

MIMI G BANSAL, MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MIMI G BANSAL M.D. (OWNER)
(516) 352-2700
Entity
Organization

Contact information

Practice address
2001 MARCUS AVE, SUITE N218, LAKE SUCCESS, NY 11042
(516) 352-2700
(516) 437-6904
Mailing address
2 POLO DR, OLD WESTBURY, NY 11568-1043
(516) 352-2700
(516) 437-6904

Taxonomy

Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
2122661
NY

Other

Enumeration date
12/13/2006
Last updated
08/22/2020
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