Healthcare Provider Details

I. General information

NPI: 1770838245
Provider Name (Legal Business Name): NEHA BANSAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COLUMBIA AVE UNIT A
CLIFFSIDE PARK NJ
07010-3018
US

IV. Provider business mailing address

80 COLUMBIA AVE UNIT A
CLIFFSIDE PARK NJ
07010-3018
US

V. Phone/Fax

Practice location:
  • Phone: 313-410-1609
  • Fax:
Mailing address:
  • Phone: 313-410-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101318
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number288255
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: