Provider Demographics
NPI:1922065861
Name:BANSAL, MEERA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEERA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 N. VILLAGE AVE
Mailing Address - Street 2:MERCY MEDICAL CENTER
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-1000
Mailing Address - Country:US
Mailing Address - Phone:516-705-2150
Mailing Address - Fax:516-705-2691
Practice Address - Street 1:1000 N VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1000
Practice Address - Country:US
Practice Address - Phone:516-705-2150
Practice Address - Fax:516-705-2691
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205627207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400009865Medicare PIN
NYG43315Medicare UPIN
NY905391Medicare ID - Type Unspecified