Healthcare Provider Details

I. General information

NPI: 1912591413
Provider Name (Legal Business Name): NITIN BANSAL, M.D, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 KENSINGTON AVE
BUFFALO NY
14215-1436
US

IV. Provider business mailing address

1515 KENSINGTON AVE
BUFFALO NY
14215-1436
US

V. Phone/Fax

Practice location:
  • Phone: 716-446-5900
  • Fax: 716-242-0225
Mailing address:
  • Phone: 716-446-5900
  • Fax: 716-242-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NITIN BANSAL
Title or Position: OWNER
Credential: MD
Phone: 716-446-5900