Provider Demographics
NPI:1205966702
Name:SHAPIRO, PHYLLIS M (LAC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E END AVE
Mailing Address - Street 2:#19F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7909
Mailing Address - Country:US
Mailing Address - Phone:212-879-0966
Mailing Address - Fax:212-879-0966
Practice Address - Street 1:250 W 57TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0001
Practice Address - Country:US
Practice Address - Phone:212-262-7448
Practice Address - Fax:212-262-7448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY714OtherNYS LICENSE