Individual provider Active NPI

Sergey Petrosian, DO

  • Dermatology Physician
  • Brooklyn, NY
National Provider Identifier
1538520192
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
290242 Issued in NY
Practice address
76 7TH Ave
Brooklyn, NY 11217-3617
Phone
(718) 238-0500
NPI assigned
Mar 10, 2016
Last updated
Jan 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 290242 NY Primary

Addresses

Primary practice location

76 7TH Ave
Brooklyn, NY 11217-3617

Mailing address

6425 Alderton St
Rego Park, NY 11374-5011
Phone (917) 306-8490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200507002252 NY Practitioner - Dermatology 0143651190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ronald R Brancaccio MD and Peter Saitta DO PCGroup PAC ID 0648351338, 23 clinicians

Practice addresses (Care Compare)

7901 4TH Ave
Suite A20
Brooklyn, NY 11209-3957
Phone (718) 491-5800

Merit-based Incentive Payment System (MIPS)

Final score
85.97 of 100Reported as group
Quality
87.04
Promoting interoperability
77
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions461
Removal or shaving of skin growth22
Skin biopsy185

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Saitta Dermatology PC Dermatology CurrentSince Jul 1, 2020 Accepting new patients
Ronald R Brancaccio MD & Peter Saitta DO PC Dermatology CurrentSince Jul 1, 2020 Accepting new patients
Siny Dermatology Florida Dermatology PastSince Mar 24, 2024 Accepting new patients
Live Beyond Medical MGMT LLC PastSince Mar 21, 2021 Accepting new patients

Locations

438 Graham Ave
Brooklyn, NY 11211
Phone (718) 349-5912

76 7th Ave
Brooklyn, NY 11217
Phone (718) 238-0500

7901 4th Ave
Ste A20
Brooklyn, NY 11209
Phone (718) 491-6900

10933 71st Rd
Ste 1F
Forest Hills, NY 11375
Phone (718) 575-2930

83A Grand Ave
Massapequa, NY 11758
Phone (516) 798-4348

69 E 76th St
New York, NY 10021
Phone (212) 288-7231

56850 Route 25
Southold, NY 11971
Phone (631) 765-1191

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1538520192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6425 ALDERTON ST",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113745011",
            "telephone_number": "917-306-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 7TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173617",
            "telephone_number": "718-238-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSIAN",
        "first_name": "SERGEY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-10",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "290242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.