Provider Demographics
NPI:1609904010
Name:MARTIN SHAPIRO DDS,PC
Entity Type:Organization
Organization Name:MARTIN SHAPIRO DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-385-3496
Mailing Address - Street 1:8 CORNELL PL
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1306
Mailing Address - Country:US
Mailing Address - Phone:516-596-9262
Mailing Address - Fax:
Practice Address - Street 1:839 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3410
Practice Address - Country:US
Practice Address - Phone:718-385-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921926Medicaid