Healthcare Provider Details

I. General information

NPI: 1275717175
Provider Name (Legal Business Name): NEW CONCEPT REHABILITATION MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 OCEAN AVE
BROOKLYN NY
11229-4521
US

IV. Provider business mailing address

16 LAMOKA AVE
STATEN ISLAND NY
10308-2025
US

V. Phone/Fax

Practice location:
  • Phone: 718-648-1111
  • Fax:
Mailing address:
  • Phone: 718-648-1111
  • Fax: 718-648-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number209819
License Number StateNY

VIII. Authorized Official

Name: DR. MIKHAIL SHAPIRO
Title or Position: PRESIDENT
Credential: DO
Phone: 718-648-1111