NPI 1003978669

Mimi G Bansal, MD

Organisation Procedural Dermatology Physician Lake Success, NY

Practice location

Address: 2001 Marcus Ave Suite N218, Lake Success, NY 11042
Phone: (516) 352-2700
Fax: (516) 437-6904
Mailing address: 2 Polo Dr, Old Westbury, NY 11568-1043

Authorised official

Name: Mimi G Bansal
Title: Owner
Phone: (516) 352-2700

Registered specialties

Procedural Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207NS0135X Licence 2122661 (NY)

Other Dermatology providers in New York →

Registry record

NPI: 1003978669
Entity type: Organization
NPI issued: 13 Dec 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.