Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 140155 | NY |
NPI | 1841591765 |
---|---|
Provider Name | Dr. Jack Martin Shapiro |
First Address | Old Westbury, NY 11568-1319 |
Second Address | Old Westbury, NY 11568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2010 |
Last Update Date | 09/11/2010 |