MEDICARE: JAGDISH BANSAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	111144	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518926724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGDISH BANSAL M.D.

Provider Business Mailing Address
First Line	:	15 QUAIL RUN
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-1044
Country	:	US
Telephone Number	:	516-626-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 RANDALL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-3617
Country	:	US
Telephone Number	:	718-842-3812
Fax Number	:	718-842-3828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/25/2007

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