Provider Demographics
NPI:1518946714
Name:BANAD, PREMANATH (MD)
Entity Type:Individual
Prefix:DR
First Name:PREMANATH
Middle Name:
Last Name:BANAD
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 1:254 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1052
Mailing Address - Country:US
Mailing Address - Phone:917-871-7927
Mailing Address - Fax:718-365-1523
Practice Address - Street 1:386 BEDFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2415
Practice Address - Country:US
Practice Address - Phone:718-365-0256
Practice Address - Fax:718-365-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152648207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838353Medicaid
NY00838353Medicaid
NY20D412Medicare PIN
NY03053Medicare PIN