Provider Demographics
NPI:1144547050
Name:BANSAL, RAGHAV
Entity type:Individual
Prefix:
First Name:RAGHAV
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:ELMHURST HOSPITAL CENTER
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-2289
Mailing Address - Fax:718-334-1738
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ROOM NO D3 22F
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257584207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology