Provider Demographics
NPI:1093741506
Name:BHANSALI, PUSHPA R (MD)
Entity Type:Individual
Prefix:MR
First Name:PUSHPA
Middle Name:R
Last Name:BHANSALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-934-7770
Mailing Address - Fax:718-934-8038
Practice Address - Street 1:2428 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-934-7770
Practice Address - Fax:718-934-8038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157668207X00000X
NY157768-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00834744Medicaid
A60933Medicare UPIN
NY00834744Medicaid