Provider Demographics
NPI:1750403697
Name:SHAPIRO, LAWRENCE (PT)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 218TH ST
Mailing Address - Street 2:OFFICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1020
Mailing Address - Country:US
Mailing Address - Phone:212-304-1755
Mailing Address - Fax:212-304-4308
Practice Address - Street 1:520 W 218TH ST
Practice Address - Street 2:OFFICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1020
Practice Address - Country:US
Practice Address - Phone:212-304-1755
Practice Address - Fax:212-304-4308
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC1519OtherOXFORD PROVIDER ID
NY133172690OtherTAX IDENTIFICATION NUMBER
NY20100POtherHIP PROVIDER NUMBER
NY6603997OtherGHI PROVIDER NUMBER
NY668349OtherAETNA ID NUMBER
NY668349OtherAETNA ID NUMBER