Mimi G Bansal, MD

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

2122661 Issued in NY

Legal business name

MIMI G BANSAL, MD

Practice address

2001 Marcus Ave
Suite N218
Lake Success, NY 11042

Phone

(516) 352-2700

Fax

(516) 437-6904

NPI assigned

Dec 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mimi G Bansal, M.D.NPI 1568563567

Title

Owner

Phone

(516) 352-2700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mimi G Bansal X, M.D.

  • Dermatology Physician
  • New Hyde Park, NY
  • NPI 1568563567
  Medicare reassignment NPD Authorized official
• Rahman Ilkhanizadeh, MD

  • Vascular Surgery Physician
  • Brooklyn, NY
  • NPI 1750300950
  NPD (past)
• Xiaoyan Song, M.D.

  • Internal Medicine Physician
  • Flushing, NY
  • NPI 1821368390
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003978669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 POLO DR",
            "city": "OLD WESTBURY",
            "state": "NY",
            "postal_code": "115681043",
            "telephone_number": "516-352-2700",
            "fax_number": "516-437-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MARCUS AVE",
            "address_2": "SUITE N218",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-352-2700",
            "fax_number": "516-437-6904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMI G BANSAL, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "MIMI",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-352-2700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "2122661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah McElroy, LMSW
• Allison Bauman Mekhoubad, DO
• David Meryash, MD
• Sanford A Meyersfield, MD
• Perry J Milman, MD
• Judy Mittleman, M.D.
• Joan B Monaghan, PT
• Bradley Michael Morganstern, M.D.
• Neil J Koppel DC PC
• Jay Matthew Neugarten, D.D.S., M.D.

• Procedural Dermatology Physician in Lake Success, NY
• Providers in Lake Success, NY by specialty
• Procedural Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.