Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 049812-1 | NY |
N | 213EG0000X | General Practice | 049812-1 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 049812-1 | NY |
NPI | 1003015926 |
---|---|
Provider Name | Slava Shapiro |
First Address | Woodbury, NY 11797-2906 |
Second Address | Syosset, NY 11791-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 05/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02491569 | (05) | NY |