Individual
ITISHA BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 MAIN ST, GME OFFICE, BRIDGEPORT, CT 06606
(203) 576-5425
Mailing address
1 ATWELL RD, COOPERSTOWN, NY 13326-1301
(607) 547-3153
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
291299
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2014
Last updated
09/04/2018
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