Provider Demographics
NPI:1053424317
Name:SHAPIRO, STEPHEN BARRY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BARRY
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LITTLE BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5100
Mailing Address - Country:US
Mailing Address - Phone:845-562-5450
Mailing Address - Fax:845-562-9118
Practice Address - Street 1:10 LITTLE BRITAIN RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5100
Practice Address - Country:US
Practice Address - Phone:845-562-5450
Practice Address - Fax:845-562-9118
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00505977Medicaid
A62405Medicare UPIN
NY00505977Medicaid