Provider Demographics
NPI:1093889115
Name:SHAPIRO, DANIEL (MD, FAAPMR)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD, FAAPMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 SILLS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8810
Mailing Address - Country:US
Mailing Address - Phone:631-654-4988
Mailing Address - Fax:631-654-0899
Practice Address - Street 1:286 SILLS RD STE 2
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8810
Practice Address - Country:US
Practice Address - Phone:631-654-4988
Practice Address - Fax:631-654-0899
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125974-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
125974OtherNEW YORK STATE LICENSE
NY11-3138090OtherTAX ID#
NYAS9629366OtherDEA #
125974OtherNEW YORK STATE LICENSE