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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