Individual
JAGDISH BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1807 RANDALL AVE, BRONX, NY 10473-3617
(718) 842-3812
(718) 842-3828
Mailing address
15 QUAIL RUN, OLD WESTBURY, NY 11568-1044
(516) 626-0429
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
111144
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00199106
—
NY
Enumeration date
03/17/2006
Last updated
10/25/2007
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