Provider Demographics
NPI:1740381516
Name:SHAPIRO, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
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 1:2148 OCEAN AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1484
Mailing Address - Country:US
Mailing Address - Phone:212-398-1288
Mailing Address - Fax:718-332-3454
Practice Address - Street 1:2148 OCEAN AVE FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1484
Practice Address - Country:US
Practice Address - Phone:123-981-2882
Practice Address - Fax:718-332-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234760207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3K5431OtherEMPIRE BCBS
NY02692937Medicaid
3K4711Medicare PIN
NYI08617Medicare UPIN
NY02692937Medicaid