=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891007670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLAVA SHAPIRO, DDS, MD , PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2010
-----------------------------------------------------
Last Update Date | 07/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 167 FROEHLICH FARM BLVD
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11797-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-677-9777
-----------------------------------------------------
Fax | 516-677-9778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 GREENWAY DR S
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-3854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-677-9777
-----------------------------------------------------
Fax | 516-677-9778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SLAVA SHAPIRO
-----------------------------------------------------
Credential | DDS, MD
-----------------------------------------------------
Telephone | 516-677-9777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 049812
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------