Provider Demographics
NPI:1164423299
Name:SAPORTA, DIEGO (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:SAPORTA
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 1:470 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1738
Mailing Address - Country:US
Mailing Address - Phone:908-352-6700
Mailing Address - Fax:908-352-6734
Practice Address - Street 1:470 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1738
Practice Address - Country:US
Practice Address - Phone:908-352-6700
Practice Address - Fax:908-352-6734
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05512700207YX0602X
NY177474-1207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
616986Medicare ID - Type Unspecified
E62162Medicare UPIN