Provider Demographics
NPI:1720064546
Name:BANSAL, ADITYA R (MD)
Entity Type:Individual
Prefix:
First Name:ADITYA
Middle Name:R
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ADITYA
Other - Middle Name:
Other - Last Name:BANSAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:741 S 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9542
Mailing Address - Country:US
Mailing Address - Phone:609-748-7300
Mailing Address - Fax:609-748-7919
Practice Address - Street 1:741 S 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9542
Practice Address - Country:US
Practice Address - Phone:609-748-7300
Practice Address - Fax:609-748-7919
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09474100207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ352996Medicare PIN