Healthcare Provider Details

I. General information

NPI: 1679694343
Provider Name (Legal Business Name): ACCURATE DERMATOLOGY P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLD COUNTRY RD SUITE 203
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 Number
License Number State

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: BIJAN SETAREH-SHENAS
Title or Position: PRESIDENT
Credential: MD
Phone: 516-822-9730