Provider Demographics
NPI:1154404192
Name:SHAPIRO, AVRAM M (DPM)
Entity type:Individual
Prefix:DR
First Name:AVRAM
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-0361
Mailing Address - Country:US
Mailing Address - Phone:917-930-3219
Mailing Address - Fax:
Practice Address - Street 1:14934 85TH ST
Practice Address - Street 2:3FL
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1223
Practice Address - Country:US
Practice Address - Phone:917-930-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003658213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00798316Medicaid
NYT51183Medicare UPIN
NYP38851Medicare ID - Type Unspecified