Provider Demographics
NPI:1073556825
Name:KANSAL, SARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:
Last Name:KANSAL
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 1:27 HIDDEN PINES CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1688
Mailing Address - Country:US
Mailing Address - Phone:716-568-1414
Mailing Address - Fax:
Practice Address - Street 1:725 ORCHARD PARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3352
Practice Address - Country:US
Practice Address - Phone:716-674-0101
Practice Address - Fax:716-712-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175096-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619612Medicaid
NY01619612Medicaid
NY244771Medicare PIN