Healthcare Provider Details

I. General information

NPI: 1114486172
Provider Name (Legal Business Name): DIVYA BHANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 STATION RD FL 5
MINEOLA NY
11501-4205
US

IV. Provider business mailing address

555 STEWART AVE UNIT 2307
GARDEN CITY NY
11530-4880
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-8657
  • Fax:
Mailing address:
  • Phone: 408-427-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number322516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: