Provider Demographics
NPI:1730263575
Name:SHAPIRO, JONATHAN (PSYD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-3834
Mailing Address - Country:US
Mailing Address - Phone:518-935-3710
Mailing Address - Fax:
Practice Address - Street 1:135 ELLIOT RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-3834
Practice Address - Country:US
Practice Address - Phone:518-935-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68857Medicare ID - Type Unspecified