Healthcare Provider Details

I. General information

NPI: 1184120727
Provider Name (Legal Business Name): GEORGE BANNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ASHFORD AVE
DOBBS FERRY NY
10522-1924
US

IV. Provider business mailing address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

V. Phone/Fax

Practice location:
  • Phone: 914-966-9787
  • Fax: 914-966-9793
Mailing address:
  • Phone: 732-836-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number315318
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: