Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 059184 | NY |
Y | 213EG0000X | General Practice | 059184 | NY |
N | 1223G0001X | General Practice | 22DI02686000 | NJ |
N | 213EG0000X | General Practice | 22DI02686000 | NJ |
NPI | 1003278128 |
---|---|
Provider Name | Samantha Shapiro |
First Address | New York, NY 10003-5217 |
Second Address | Brooklyn, NY 11206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 30/08/2018 |