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NPI Code Detail

MEDICARE: SANJIV BANSAL MD PC

MEDICARE: SANJIV BANSAL MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician191686NY

General Provider Information

NPI Number : 1174512826
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANJIV BANSAL MD PC
Provider Business Mailing Address
First Line : 192 SHEPHERD LN
Second Line :
City : ROSLYN HEIGHTS
State : NY
Zip : 11577-2509
Country : US
Telephone Number : 718-515-9800
Fax Number : 718-231-7942
Provider Business Practice Location Address
First Line : 2705 WILLIAMSBRIDGE RD
Second Line :
City : BRONX
State : NY
Zip : 10469-4109
Country : US
Telephone Number : 718-515-9800
Fax Number : 718-231-7942
Authorized Official
Title or Position : PRESIDENT
Name : SANJIV BANSAL
Credential : MD
Telephone Number : 718-515-7800
Provider Enumeration Date : 10/17/2005
Last Update Date : 08/22/2020

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