Provider Demographics
NPI:1659377422
Name:SHAPIRO, JONATHAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
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 1:4601 FIELDSTON RD
Mailing Address - Street 2:APT 6L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3313
Mailing Address - Country:US
Mailing Address - Phone:718-543-5054
Mailing Address - Fax:646-706-7111
Practice Address - Street 1:115 E 61ST STREET
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8184
Practice Address - Country:US
Practice Address - Phone:212-752-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75889Medicare UPIN
NY446B41Medicare ID - Type Unspecified