Healthcare Provider Details

I. General information

NPI: 1033672266
Provider Name (Legal Business Name): RACHNA BANGDIWALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 HEMPSTEAD TPKE
BETHPAGE NY
11714-5713
US

IV. Provider business mailing address

4295 HEMPSTEAD TPKE
BETHPAGE NY
11714-5713
US

V. Phone/Fax

Practice location:
  • Phone: 516-579-3500
  • Fax: 516-579-3802
Mailing address:
  • Phone: 516-579-3500
  • Fax: 516-579-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: