Provider Demographics
NPI:1326047572
Name:SAPORITO,JR, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SAPORITO,JR
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 1:1124 E RIDGEWOOD AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3915
Mailing Address - Country:US
Mailing Address - Phone:201-689-9400
Mailing Address - Fax:201-689-9404
Practice Address - Street 1:1124 E RIDGEWOOD AVE
Practice Address - Street 2:STE 202
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3915
Practice Address - Country:US
Practice Address - Phone:201-689-9400
Practice Address - Fax:201-689-9404
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56519Medicare UPIN
NJ068833WC0Medicare PIN