Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 150306-1 | NY |
Y | 213ES0000X | Sports Medicine | 150306-1 | NY |
NPI | 1275615478 |
---|---|
Provider Name | Dr. Eric Dale Shapiro |
First Address | West Islip, NY 11795-4403 |
Second Address | West Islip, NY 11795-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06016 | (02) | NY |