Provider Demographics
NPI:1033180880
Name:BANSAL, NIVEDITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 ROUTE 46 WEST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 ROUTE 46 WEST
Practice Address - Street 2:SUITE #2
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-349-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08318700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine