Provider Demographics
NPI:1306842646
Name:BANIK, BHOLA N (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:BHOLA
Middle Name:N
Last Name:BANIK
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 OLD COUNTRY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6505
Mailing Address - Country:US
Mailing Address - Phone:516-931-3131
Mailing Address - Fax:
Practice Address - Street 1:1097 OLD COUNTRY RD
Practice Address - Street 2:STE 103
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6505
Practice Address - Country:US
Practice Address - Phone:516-931-3131
Practice Address - Fax:516-931-3140
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119027207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00222380Medicaid
NYW6L381Medicare ID - Type Unspecified
NYC08435Medicare UPIN