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Individual

DR. PREMANATH BANAD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
386 BEDFORD PARK BLVD, BRONX, NY 10458-2415
(718) 365-0256
(718) 365-1523
Mailing address
254 CENTER ST, WILLISTON PARK, NY 11596-1052
(917) 871-7927
(718) 365-1523

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
152648
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00838353
NY
Enumeration date
01/16/2006
Last updated
05/08/2014
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