Provider Demographics
NPI:1801979224
Name:SHAPIRO, ILAN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:ILAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2036
Mailing Address - Country:US
Mailing Address - Phone:631-355-6068
Mailing Address - Fax:
Practice Address - Street 1:436 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2036
Practice Address - Country:US
Practice Address - Phone:631-355-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOT 581Medicare ID - Type Unspecified