Provider Demographics
NPI:1063856441
Name:BARTENSTEIN, MAYURIKA BANERJEE
Entity Type:Individual
Prefix:
First Name:MAYURIKA
Middle Name:BANERJEE
Last Name:BARTENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MELLWOOD AVE
Mailing Address - Street 2:APT.1311
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1061
Mailing Address - Country:US
Mailing Address - Phone:502-592-8499
Mailing Address - Fax:
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:SUITE 525
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4509
Practice Address - Country:US
Practice Address - Phone:714-456-5631
Practice Address - Fax:714-285-0389
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program