Provider Demographics
NPI:1558362673
Name:BANDARI, DON B (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:B
Last Name:BANDARI
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:PO BOX 234041
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-4041
Mailing Address - Country:US
Mailing Address - Phone:718-787-0400
Mailing Address - Fax:718-375-6189
Practice Address - Street 1:1664 E 14TH ST
Practice Address - Street 2:201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1155
Practice Address - Country:US
Practice Address - Phone:718-787-0400
Practice Address - Fax:718-375-6189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY199970207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01780478Medicaid
NY01780478Medicaid
NYW39961Medicare ID - Type Unspecified