Provider Demographics
NPI:1457377509
Name:BANIA, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:BANIA
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:PO BOX 1871
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-0908
Mailing Address - Country:US
Mailing Address - Phone:516-739-3862
Mailing Address - Fax:516-747-4783
Practice Address - Street 1:1 BIRCHWOOD CT
Practice Address - Street 2:3E
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4524
Practice Address - Country:US
Practice Address - Phone:516-739-3862
Practice Address - Fax:516-747-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99931Medicare UPIN
NY22S301Medicare ID - Type Unspecified