Individual
KAILASS BANSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12719 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-2803
(718) 641-8100
Mailing address
12719 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-2803
(718) 641-8100
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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