Provider Demographics
NPI:1588739148
Name:SHAPIRO, EDITH TENNENBAUM (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:TENNENBAUM
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:277 S BROADWAY
Mailing Address - Street 2:APT. E
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5334
Mailing Address - Country:US
Mailing Address - Phone:914-332-1755
Mailing Address - Fax:
Practice Address - Street 1:200 ENGLE ST
Practice Address - Street 2:SUITE 27
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2440
Practice Address - Country:US
Practice Address - Phone:201-871-3027
Practice Address - Fax:201-569-7264
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA022574002084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050643OtherVALUE OPTIONS
NJ229708OtherCOMPSYCH
NJ0015271OtherGHI
NJ050643OtherVALUE OPTIONS