NPIMap

Organization Active NPI

Mitchell N Shapiro DDS PC

  • Dentist
  • Smithtown, NY
National Provider Identifier
1073993218
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
036755 Issued in NY
Legal business name
MITCHELL N SHAPIRO DDS PC
Practice address
373 Route 111
Ste 16
Smithtown, NY 11787-4759
Phone
(631) 265-2700
Fax
(631) 265-1162
NPI assigned
Jun 3, 2015
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mitchell N Shapiro, DDSNPI 1790907566
Title
Owner
Phone
(631) 265-2700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 036755 NY Primary

Addresses

Primary practice location

373 Route 111
Ste 16
Smithtown, NY 11787-4759

Mailing address

373 Route 111
Ste 16
Smithtown, NY 11787-4759
Phone (631) 265-2700

Other names 1

  • CENTER FOR COSMETIC DENTISTRY Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150926000286 NY DME Supplier - Oral Surgery - Dentist 5193033033 Practice locations: Smithtown, NY

National Provider Directory

National Provider Directory

Locations

373 Route 111
Ste 16
Smithtown, NY 11787
Phone (631) 265-2700

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1073993218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 ROUTE 111",
            "address_2": "STE 16",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874759",
            "telephone_number": "631-265-2700",
            "fax_number": "631-265-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 ROUTE 111",
            "address_2": "STE 16",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874759",
            "telephone_number": "631-265-2700",
            "fax_number": "631-265-1162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL N SHAPIRO DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-265-2700",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "036755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTER FOR COSMETIC DENTISTRY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.