Healthcare Provider Details

I. General information

NPI: 1518036698
Provider Name (Legal Business Name): EUGENE SHAPIRO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OCEAN VIEW AVE
BROOKLYN NY
11235
US

IV. Provider business mailing address

301 OCEAN VIEW AVE
BROOKLYN NY
11235-6826
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-2582
  • Fax: 718-743-3963
Mailing address:
  • Phone: 718-332-2582
  • Fax: 718-743-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0041801
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001028-1
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier00989813
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: