Provider Demographics
NPI:1386610228
Name:SHAPIRO, GARY I (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:I
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 ARK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3100
Mailing Address - Country:US
Mailing Address - Phone:856-778-4756
Mailing Address - Fax:856-778-1742
Practice Address - Street 1:204 ARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3100
Practice Address - Country:US
Practice Address - Phone:856-778-4756
Practice Address - Fax:856-778-1742
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06119800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6931707Medicaid
NJ6931707Medicaid