MEDICARE: DR. TARA E. SHAPIRO D.O,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	200696-1	NY

General Provider Information

NPI Number	:	1083771273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA E. SHAPIRO D.O,

Provider Business Mailing Address
First Line	:	100 LEBER RD
Second Line	:
City	:	BLAUVELT
State	:	NY
Zip	:	10913-1405
Country	:	US
Telephone Number	:	845-365-2521
Fax Number	:	914-407-1697

Provider Business Practice Location Address
First Line	:	2432 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5204
Country	:	US
Telephone Number	:	718-518-5046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/28/2022

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