Healthcare Provider Details

I. General information

NPI: 1013917665
Provider Name (Legal Business Name): BIJAN SETAREH-SHENAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLD COUNTRY RD SUITE203
PLAINVIEW NY
11803-4932
US

IV. Provider business mailing address

1550 E 7TH ST
BROOKLYN NY
11230-6406
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-9730
  • Fax: 516-822-9764
Mailing address:
  • Phone: 718-787-2215
  • Fax: 718-787-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number214882
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02109566
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: