Provider Demographics
NPI:1508868670
Name:ASSOCIATES IN ENT & ALLERGY PA
Entity Type:Organization
Organization Name:ASSOCIATES IN ENT & ALLERGY PA
Other - Org Name:DIEGO SAPORTA MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPORTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-352-6700
Mailing Address - Street 1:470 NORTH AVENUE
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 AVENUE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
NJ25MA05512700207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080664Medicare ID - Type Unspecified