Provider Demographics
NPI:1437206943
Name:LAPORTA, CHERESE M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERESE
Middle Name:M
Last Name:LAPORTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N OCEAN AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2012
Mailing Address - Country:US
Mailing Address - Phone:631-654-5004
Mailing Address - Fax:631-654-5048
Practice Address - Street 1:107 N OCEAN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2012
Practice Address - Country:US
Practice Address - Phone:631-654-5004
Practice Address - Fax:631-654-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF36219Medicare UPIN
NY34V651Medicare ID - Type Unspecified