Provider Demographics
NPI:1306821004
Name:DEPORTO, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DEPORTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8303
Mailing Address - Country:US
Mailing Address - Phone:646-370-2040
Mailing Address - Fax:646-370-2012
Practice Address - Street 1:314 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8303
Practice Address - Country:US
Practice Address - Phone:646-370-2040
Practice Address - Fax:646-370-2012
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2090352081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01905691Medicaid
NYG89955Medicare UPIN
NY004022Medicare PIN