Provider Demographics
NPI:1407897333
Name:KANSAL, NARENDRA (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:KANSAL
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ORCHARD PARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3352
Mailing Address - Country:US
Mailing Address - Phone:716-675-5010
Mailing Address - Fax:716-712-0767
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:716-675-5010
Practice Address - Fax:716-712-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173996-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01065374Medicaid
043591Medicare ID - Type Unspecified
NY01065374Medicaid