Provider Demographics
NPI:1477533644
Name:GANGULY, BIMALENDU (MD)
Entity Type:Individual
Prefix:
First Name:BIMALENDU
Middle Name:
Last Name:GANGULY
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 1:29 CHICKEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2103
Mailing Address - Country:US
Mailing Address - Phone:718-379-1800
Mailing Address - Fax:516-759-3033
Practice Address - Street 1:140 BENCHLEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3502
Practice Address - Country:US
Practice Address - Phone:718-379-1800
Practice Address - Fax:718-320-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120147207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0039095OtherGROUP HEALTH INCORPORATED
NY00436668Medicaid
NY120147OtherHEALTH INSURANCE PLAN
NY0039095OtherGROUP HEALTH INCORPORATED
NY00436668Medicaid