Provider Demographics
NPI:1588627988
Name:BANSAL, RAJENDRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:K
Last Name:BANSAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:635 W 165TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3724
Mailing Address - Country:US
Mailing Address - Phone:212-305-2241
Mailing Address - Fax:212-305-3276
Practice Address - Street 1:635 W 165TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:212-350-2241
Practice Address - Fax:212-305-3276
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-05-12
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Provider Licenses
StateLicense IDTaxonomies
NY133378-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD46778Medicare UPIN