Healthcare Provider Details

I. General information

NPI: 1265650402
Provider Name (Legal Business Name): DAVID SHAPIRO O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEERPARK DR
MONMOUTH JCT NJ
08852-1919
US

IV. Provider business mailing address

108 PALMER RD
PENNINGTON NJ
08534-1819
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-1122
  • Fax:
Mailing address:
  • Phone: 609-466-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00114800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: