Provider Demographics
NPI:1093879447
Name:SHOPSIN, BO (MD-PHD)
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:SHOPSIN
Suffix:
Gender:M
Credentials:MD-PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:318 E 15TH ST APT 11E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4015
Mailing Address - Country:US
Mailing Address - Phone:212-263-6400
Mailing Address - Fax:212-263-7369
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NEW BELLEVUE, 16, 16S5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-6400
Practice Address - Fax:212-263-7369
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231745207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231745OtherSTATE LICENSE