Healthcare Provider Details

I. General information

NPI: 1437335510
Provider Name (Legal Business Name): EUGENE SHAPIRO DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OCEAN VIEW AVE
BROOKLYN NY
11235-6826
US

IV. Provider business mailing address

301 OCEAN VIEW AVE
BROOKLYN NY
11235-6826
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-3963
  • Fax:
Mailing address:
  • Phone: 718-743-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004180-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberN004180-1
License Number StateNY

VIII. Authorized Official

Name: DR. EUGENE SHAPIRO
Title or Position: PHYSICIAN
Credential: DPM
Phone: 718-332-2582