Healthcare Provider Details

I. General information

NPI: 1689463408
Provider Name (Legal Business Name): 4B BANSALS BRAIN BODY & BEHAVIORAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CAMPUS VIEW BLVD STE 200
COLUMBUS OH
43235-4678
US

IV. Provider business mailing address

200 E CAMPUS VIEW BLVD STE 200
COLUMBUS OH
43235-4678
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-3434
  • Fax: 614-985-3601
Mailing address:
  • Phone: 614-864-3434
  • Fax: 614-985-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GIRRAJ KISHORE BANSAL
Title or Position: PHYSICIAN
Credential:
Phone: 614-864-3434