Provider Demographics
NPI:1366087124
Name:BANGA, JEFFREY U
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:U
Last Name:BANGA
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 1:3390 BANKS RD APT 109
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6952
Mailing Address - Country:US
Mailing Address - Phone:903-985-5550
Mailing Address - Fax:
Practice Address - Street 1:3390 BANKS RD APT 109
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-6952
Practice Address - Country:US
Practice Address - Phone:903-985-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant