Individual
DR. PRADEEP BANSAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 N VILLAGE AVE STE 411, ROCKVILLE CENTRE, NY 11570-1001
(516) 593-4451
(516) 593-6202
Mailing address
2000 N VILLAGE AVE STE 411, ROCKVILLE CENTRE, NY 11570-1001
(516) 593-4451
(516) 593-6202
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
192386
NY
207RG0100X
Gastroenterology Physician
Primary
1923861
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01717284
—
NY
Enumeration date
01/04/2006
Last updated
07/19/2019
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