Provider Demographics
NPI:1639240039
Name:BANDOVIC, JELA (MD)
Entity Type:Individual
Prefix:
First Name:JELA
Middle Name:
Last Name:BANDOVIC
Suffix:
Gender:F
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:NSUH-DEPT OF PATHOLOGY
Mailing Address - Street 2:300 COMMUNITY DRIVE
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-562-4114
Mailing Address - Fax:
Practice Address - Street 1:NSUH-DEPT OF PATHOLOGY
Practice Address - Street 2:300 COMMUNITY DRIVE
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232249207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology