Healthcare Provider Details

I. General information

NPI: 1649438672
Provider Name (Legal Business Name): JEFFREY BANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1190 5TH AVE
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-410-7196
Mailing address:
  • Phone: 212-427-1540
  • Fax: 212-410-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number238699
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number238699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: