MIMI G BANSAL, MD
NPI 1003978669
Dermatology - Procedural Dermatology in Lake Success, NY
About Mimi G Bansal, Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MIMI G BANSAL, MD (NPI 1003978669) is a healthcare organization registered as a procedural dermatology in Lake Success, New York and active in the NPI registry since December 2006. The organization lists Mimi G Bansal, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mimi G Bansal, Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Mimi G Bansal, MD, which bills Medicare for the services this clinician delivers.
Clinician (1)
New Hyde Park, NY 11042
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mimi G Bansal, MD's NPI number?
The NPI number for Mimi G Bansal, MD is 1003978669. It was assigned to this organization in the NPPES registry on December 13, 2006.
Where is Mimi G Bansal, MD located?
Mimi G Bansal, MD is located at 2001 Marcus Ave Suite N218, Lake Success, NY 11042. The listed phone number is (516) 352-2700.
What is Mimi G Bansal, MD's specialty?
The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.
Is Mimi G Bansal, MD enrolled in Medicare?
Yes. Mimi G Bansal, MD is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mimi G Bansal, MD?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Mimi G Bansal, MD. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Mimi G Bansal, MD was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mimi G Bansal, Md · NPI 1003978669
Procedural Dermatology organization in Lake Success, New York. Organization record, active in the CMS NPPES registry since December 13, 2006.
## Identity
- **NPI:** 1003978669 (Entity type: Organization)
- **Enumerated:** December 13, 2006
- **Primary specialty:** Dermatology - Procedural Dermatology · taxonomy 207NS0135X
- **Organization subpart:** No
- **Authorized official:** Mimi Bansal, OWNER
## Practice location
- **Address:** 2001 MARCUS AVE, SUITE N218, Lake Success, NY 11042
- **Phone:** (516) 352-2700 · **Fax:** (516) 437-6904
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1003978669) · Data from the CMS NPPES public registry.