Individual
DR. MIMI G BANSAL X
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 MARCUS AVE, SUITE N218, NEW HYDE PARK, NY 11042-1011
(516) 352-2700
(516) 437-6904
Mailing address
2 POLO DR, OLD WESTBURY, NY 11568-1043
(516) 352-2700
(516) 437-6904
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
212266-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2529062
AETNA
NY
01
—
3C2836
HEALTHNET
NY
01
—
3K8631
EMPIRE BCBS
NY
01
—
P1916938
OXFORD
NY
Enumeration date
09/25/2006
Last updated
07/08/2007
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