Provider Demographics
NPI:1720155765
Name:SHAPIRO, ROY M (PHD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WEST 10 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8760
Mailing Address - Country:US
Mailing Address - Phone:212-475-8899
Mailing Address - Fax:212-475-8899
Practice Address - Street 1:23 WEST 10 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8760
Practice Address - Country:US
Practice Address - Phone:212-475-8899
Practice Address - Fax:212-475-8899
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4850103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSB81500VMedicaid
V11101Medicare ID - Type Unspecified
NYSB81500VMedicaid