MEDICARE: DR. GEORGE EUGENE SHAPIRO PHD PSYCHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0033271	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V921X	OTHER		EMPIRE BLUE CROSS BLUE SH
2	V1005	OTHER		EMPIRE BCBS

General Provider Information

NPI Number	:	1467538694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE EUGENE SHAPIRO PHD PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	ONE IPSWICH AVE
Second Line	:	328
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3263
Country	:	US
Telephone Number	:	516-487-1328
Fax Number	:	516-466-2993

Provider Business Practice Location Address
First Line	:	211 W 56 ST
Second Line	:	APT 5K
City	:	NEW YORK CITY
State	:	NY
Zip	:	10019-4312
Country	:	US
Telephone Number	:	212-307-0582
Fax Number	:	516-466-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/20/2007

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