Provider Demographics
NPI:1104869791
Name:SHAPIRO, MICHAEL B (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:651 CONEY ISLAND AVE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4306
Mailing Address - Country:US
Mailing Address - Phone:718-826-2000
Mailing Address - Fax:718-826-2100
Practice Address - Street 1:651 CONEY ISLAND AVE
Practice Address - Street 2:SUITE #C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4306
Practice Address - Country:US
Practice Address - Phone:718-826-2000
Practice Address - Fax:718-826-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040065002085R0202X
NY135080-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00508109Medicaid
NJ5055504Medicaid
NYA400129318Medicare PIN
NJD99912Medicare UPIN
NY00508109Medicaid