Healthcare Provider Details

I. General information

NPI: 1295166015
Provider Name (Legal Business Name): LEE SHAPIRO PRODUCTIONSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 PROSPECT AVE LPC
HACKENSACK NJ
07601-2569
US

IV. Provider business mailing address

245 PROSPECT AVE LPC
HACKENSACK NJ
07601-2569
US

V. Phone/Fax

Practice location:
  • Phone: 201-208-5201
  • Fax:
Mailing address:
  • Phone: 201-208-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number40022666552
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEE SHAPIRO
Title or Position: PRESIDENT
Credential:
Phone: 201-208-5201