Provider Demographics
NPI:1134459407
Name:JOON J BANG, MD, PC
Entity Type:Organization
Organization Name:JOON J BANG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-768-1264
Mailing Address - Street 1:200 PROSPECT PARK W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5747
Mailing Address - Country:US
Mailing Address - Phone:718-768-1264
Mailing Address - Fax:718-768-0254
Practice Address - Street 1:200 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5747
Practice Address - Country:US
Practice Address - Phone:718-768-1264
Practice Address - Fax:718-768-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00275741Medicaid
NY00275741Medicaid