Basic Information
Provider Information
NPI: 1003152174
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BANSAL
FirstName: NEHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 535 MAIN ST
Address2:  
City: OLEAN
State: NY
PostalCode: 147601500
CountryCode: US
TelephoneNumber: 7163720141
FaxNumber: 7163726421
Practice Location
Address1: 535 MAIN ST
Address2:  
City: OLEAN
State: NY
PostalCode: 147601500
CountryCode: US
TelephoneNumber: 7163720141
FaxNumber: 7163726421
Other Information
ProviderEnumerationDate: 12/18/2012
LastUpdateDate: 07/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X279896NYY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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