MEDICARE: DIEGO SAPORTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0602X	Otolaryngic Allergy Physician	25MA05512700	NJ
2	207YX0602X	Otolaryngic Allergy Physician	177474-1	NY

General Provider Information

NPI Number	:	1164423299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO SAPORTA M.D.

Provider Business Mailing Address
First Line	:	470 NORTH AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1738
Country	:	US
Telephone Number	:	908-352-6700
Fax Number	:	908-352-6734

Provider Business Practice Location Address
First Line	:	470 NORTH AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1738
Country	:	US
Telephone Number	:	908-352-6700
Fax Number	:	908-352-6734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	06/04/2012

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