Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 238888 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 238888 | NY |
NPI | 1174707608 |
---|---|
Provider Name | Nisha Bansal |
First Address | Staten Island, NY 10305-3408 |
Second Address | Staten Island, NY 10305-3408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02938310 | (05) | NY |