Provider Demographics
NPI:1679653307
Name:BANSAL, RAJIV (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
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 1:2001 MARCUS AVE E130
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1051
Mailing Address - Country:US
Mailing Address - Phone:516-437-6900
Mailing Address - Fax:516-437-6904
Practice Address - Street 1:2001 MARCUS AVE E130
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1051
Practice Address - Country:US
Practice Address - Phone:516-437-6900
Practice Address - Fax:516-437-6904
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2036551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2036551OtherHIP
NY3C8523OtherHEALTHNET
NYG12819Medicare UPIN
NY3C8523OtherHEALTHNET