OrganizationActive
Mimi G Bansal, MD
NPI 1003978669 · Procedural Dermatology Physician · Lake Success, NY
Provider details
- NPI number
- 1003978669
- Entity type
- Organization
- Primary specialty
- Procedural Dermatology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Mimi Bansal, Owner
- License
- 2122661 (NY)
Practice location
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
Registry dates
- Enumerated
- 2006-12-13
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.