Provider Demographics
NPI:1285640698
Name:SETIA, DEEPAK (MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:SETIA
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 1:385 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1340
Mailing Address - Country:US
Mailing Address - Phone:718-821-1222
Mailing Address - Fax:
Practice Address - Street 1:385 SENECA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1340
Practice Address - Country:US
Practice Address - Phone:718-821-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00495414Medicaid
NYB13369Medicare UPIN
NY34A121Medicare ID - Type Unspecified