Provider Demographics
NPI:1013917665
Name:SETAREH-SHENAS, BIJAN (MD)
Entity Type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:SETAREH-SHENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6406
Mailing Address - Country:US
Mailing Address - Phone:718-787-2215
Mailing Address - Fax:718-787-1899
Practice Address - Street 1:700 OLD COUNTRY RD
Practice Address - Street 2:SUITE203
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4932
Practice Address - Country:US
Practice Address - Phone:516-822-9730
Practice Address - Fax:516-822-9764
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214882207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109566Medicaid
13U061Medicare PIN
2K5541Medicare PIN
NYHI6567Medicare UPIN