Provider Demographics
NPI:1295773570
Name:SHAPIRO, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
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 1:120 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2127
Mailing Address - Country:US
Mailing Address - Phone:908-231-0265
Mailing Address - Fax:908-231-1612
Practice Address - Street 1:286 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3006
Practice Address - Country:US
Practice Address - Phone:908-231-1999
Practice Address - Fax:908-231-1612
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA25631207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2084503Medicaid
NJ2084503Medicaid
NJD90509Medicare UPIN