1619119195 NPI number — MS. ROCHELLE SHAPIRO PT

Table of content: MS. ROCHELLE SHAPIRO PT (NPI 1619119195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619119195 NPI number — MS. ROCHELLE SHAPIRO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAPIRO
Provider First Name:
ROCHELLE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619119195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PEACHTREE CT
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
HOLBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11741-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-467-3700
Provider Business Mailing Address Fax Number:
631-467-0928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 BASSETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-698-0359
Provider Business Practice Location Address Fax Number:
716-688-0207
Provider Enumeration Date:
03/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3710 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 004156-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)