Provider Demographics
NPI:1467462416
Name:SHAPNIK, BELLA (MD)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:SHAPNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:SHAPNIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2150 CENTER AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5806
Mailing Address - Country:US
Mailing Address - Phone:201-461-2444
Mailing Address - Fax:201-461-7148
Practice Address - Street 1:2150 CENTER AVE
Practice Address - Street 2:SUITE1B BELLA SHAPNIK MDPA
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-461-2444
Practice Address - Fax:201-461-7148
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070333173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8150401Medicaid
NJ8150401Medicaid
NJG51355Medicare UPIN