=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639276694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAPIRO AND BORENSTEIN DERMATOLOGY LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11030 RCA CENTER DR SUITE 3015
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-776-7041
-----------------------------------------------------
Fax | 561-776-7043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11030 RCA CENTER DR SUITE 3015
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-776-7041
-----------------------------------------------------
Fax | 561-776-7043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN PARTNER
-----------------------------------------------------
Name | STEVEN DAVID SHAPIRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-776-7041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME89837
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME56948
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------