Individual
BANI VIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1333 BROADWAY, NEW YORK, NY 10018-7204
(212) 849-0146
Mailing address
1333 BROADWAY, NEW YORK, NY 10018-7204
(212) 849-0146
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA08099900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8751404
—
NJ
Enumeration date
10/20/2006
Last updated
09/01/2010
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