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General NPI Number Information
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NPI Number | 1518926724
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Entity Type | Individual
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Provider Name | JAGDISH BANSAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1807 RANDALL AVE
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City | BRONX
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State | NY
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Zip | 10473-3617
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Country | US
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Telephone | 718-842-3812
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Fax | 718-842-3828
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Provider Business Mailing Address
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Address Line | 15 QUAIL RUN
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City | OLD WESTBURY
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State | NY
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Zip | 11568-1044
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Country | US
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Telephone | 516-626-0429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 111144
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License Number State | NY
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