Provider Demographics
NPI:1992754196
Name:SHAPIRA, SHMUEL (MD)
Entity type:Individual
Prefix:
First Name:SHMUEL
Middle Name:
Last Name:SHAPIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FAR HORIZONS DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1077
Mailing Address - Country:US
Mailing Address - Phone:845-741-2593
Mailing Address - Fax:
Practice Address - Street 1:33 FAR HORIZONS DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1077
Practice Address - Country:US
Practice Address - Phone:845-741-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257023207RC0000X
MS19067207RC0000X
NY248564207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05051297Medicaid
VA1992754196Medicaid
MS060000844Medicare PIN
VAP01490855Medicare PIN
MSE24752Medicare UPIN
VA1992754196Medicaid