Provider Demographics
NPI:1588803365
Name:BANSAL, KANTI LAL (MD)
Entity Type:Individual
Prefix:
First Name:KANTI
Middle Name:LAL
Last Name:BANSAL
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 1:1955 1ST AVE
Mailing Address - Street 2:APT 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6408
Mailing Address - Country:US
Mailing Address - Phone:347-423-4525
Mailing Address - Fax:
Practice Address - Street 1:1955 1ST AVE
Practice Address - Street 2:APT 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6408
Practice Address - Country:US
Practice Address - Phone:347-423-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1871846207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine