Provider Demographics
NPI:1215019161
Name:SHAPIRO, ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W MERRICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5707
Mailing Address - Country:US
Mailing Address - Phone:516-825-3860
Mailing Address - Fax:516-599-6257
Practice Address - Street 1:66 W MERRICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5707
Practice Address - Country:US
Practice Address - Phone:516-825-3860
Practice Address - Fax:516-599-6257
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004141-1213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1W201OtherMEDICARE ID-TYPE UNSPECIFIED
NYT51390Medicare UPIN