Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 214882 | NY |
NPI | 1013917665 |
---|---|
Provider Name | Bijan Setareh-Shenas |
First Address | Brooklyn, NY 11230-6406 |
Second Address | Plainview, NY 11803-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02109566 | (05) | NY |
HI6567 | (02) | NY |