Provider Demographics
NPI:1992754634
Name:SHAPIRO, LEONID (MD)
Entity type:Individual
Prefix:DR
First Name:LEONID
Middle Name:
Last Name:SHAPIRO
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:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0334
Mailing Address - Country:US
Mailing Address - Phone:201-803-0191
Mailing Address - Fax:201-608-7171
Practice Address - Street 1:790 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1142
Practice Address - Country:US
Practice Address - Phone:201-448-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06604400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1548544604OtherNPI
NJ7329105Medicaid
NJ1346505096OtherNPI
NJ050070740OtherRAILROAD MEDICARE
NY02057270Medicaid
NJ7329105Medicaid
NJ959036Medicare PIN
NJ959036ZSXEMedicare PIN