Provider Demographics
NPI:1649350315
Name:BABU S BANGARU MD PC
Entity type:Organization
Organization Name:BABU S BANGARU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABU
Authorized Official - Middle Name:S
Authorized Official - Last Name:BANGARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-592-7797
Mailing Address - Street 1:9422 59TH AVE STE E-1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5151
Mailing Address - Country:US
Mailing Address - Phone:718-592-7797
Mailing Address - Fax:718-685-2777
Practice Address - Street 1:9422 59TH AVE STE E-1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-592-7797
Practice Address - Fax:718-685-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1282352080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty