| Doctor Name: | AWISHA BANSAL |
| NPI Number: | 1750740791 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 25MP00391100 |
| Business Practice Address: | 23 Lorrigan Pl North Arlington, NJ - 070315826 |
| Business Phone Number: | 2019826185 |
| Business Fax Number: | |
| Mailing Address: | 23 Lorrigan Pl, NORTH ARLINGTON |
| State: | NJ |
| Postal Code: | 070315826 |
| Phone Number: | 2019826185 |
| Fax Number: | |
| NPI Enumeration Date: | 02/18/2016 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 25MP00391100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |