Individual provider · NPI-1

Dr. Ishita Bansal

Internal Medicine, Nephrology · Mineola, NY

NPI number1265789846
StatusActive
Last updated in NPPESJun 6, 2022

Details

NPI
1265789846
Entity type
Individual (NPI-1)
Name
Dr. Ishita Bansal
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 13, 2012
Certification date
Jun 6, 2022
Last updated
Jun 6, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RN0300X Internal Medicine, Nephrology284014NYYes
207R00000X Internal Medicine284014NY

Practice location

200 Old Country Rd Ste 135
Mineola, NY 11501-4237

Phone 516-663-2169

Mailing address

7901 Broadway
C7 -10
Elmhurst, NY 11373-1329

Other practice locations

7901 Broadway
C7 -10
Elmhurst, NY 11373

Phone 718-334-4000

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