Individual
BANSHARI MRIDHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 SAINT PAULS PL, GREAT NECK, NY 11021-2636
(516) 466-3001
Mailing address
43 WILLOW WOOD LN FL 2, STATEN ISLAND, NY 10308-1868
(347) 530-4010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P130582
NY
Other
Enumeration date
11/21/2024
Last updated
12/03/2024
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