Provider Demographics
NPI:1316299142
Name:SHAPIRO, BORIS (LAC)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 W 11TH ST
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3541
Mailing Address - Country:US
Mailing Address - Phone:917-459-5220
Mailing Address - Fax:
Practice Address - Street 1:2034 W 11TH ST
Practice Address - Street 2:3 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3541
Practice Address - Country:US
Practice Address - Phone:917-459-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist