Healthcare Provider Details

I. General information

NPI: 1164423299
Provider Name (Legal Business Name): DIEGO SAPORTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NORTH AVE
ELIZABETH NJ
07208-1738
US

IV. Provider business mailing address

470 NORTH AVE
ELIZABETH NJ
07208-1738
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-6700
  • Fax: 908-352-6734
Mailing address:
  • Phone: 908-352-6700
  • Fax: 908-352-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number25MA05512700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number177474-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: