Provider Demographics
NPI:1275615478
Name:SHAPIRO, ERIC DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DALE
Last Name:SHAPIRO
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 1:380 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4403
Mailing Address - Country:US
Mailing Address - Phone:631-422-6600
Mailing Address - Fax:631-422-8503
Practice Address - Street 1:380 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4403
Practice Address - Country:US
Practice Address - Phone:631-422-6600
Practice Address - Fax:631-422-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150306-12081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06016Medicare UPIN