Provider Demographics
NPI:1114082195
Name:SETTON, MICHAEL DAVID (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SETTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 E MAIN ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2800
Mailing Address - Country:US
Mailing Address - Phone:631-277-1600
Mailing Address - Fax:631-277-1638
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2800
Practice Address - Country:US
Practice Address - Phone:631-277-1600
Practice Address - Fax:631-277-1638
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0106102085R0202X
NY2476152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02976401Medicaid
NYA400000087Medicare PIN
NYA400000057Medicare PIN
NY02976401Medicaid
NYA400000059Medicare PIN
NYA400000058Medicare PIN