Provider Demographics
NPI:1700050051
Name:CHERESE M. LAPORTA D.O., PLLC
Entity Type:Organization
Organization Name:CHERESE M. LAPORTA D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-654-5004
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF36219Medicare UPIN
NYWED731Medicare PIN