Healthcare Provider Details

I. General information

NPI: 1558362673
Provider Name (Legal Business Name): DON B BANDARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date: 03/23/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1652 E 14TH ST STE 100
BROOKLYN NY
11229-1198
US

IV. Provider business mailing address

PO BOX 234041
GREAT NECK NY
11023-4041
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-0400
  • Fax: 718-787-1077
Mailing address:
  • Phone: 718-787-0400
  • Fax: 718-375-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number199970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: