Provider Demographics
NPI:1861421992
Name:RUZAL-SHAPIRO, CARRIE BRENDA (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BRENDA
Last Name:RUZAL-SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # MC28
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-1948
Mailing Address - Fax:212-305-5777
Practice Address - Street 1:630 W 168TH ST # MC28
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-1948
Practice Address - Fax:212-305-5777
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1549762085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086740Medicaid
NY02186203OtherMEDICAID GROUP #
NYW35021OtherMEDICARE GROUP #
NY22E761Medicare UPIN
NY01086740Medicaid