Healthcare Provider Details

I. General information

NPI: 1306821004
Provider Name (Legal Business Name): ROBERT DEPORTO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E 30TH ST
NEW YORK NY
10016-8303
US

IV. Provider business mailing address

314 E 30TH ST
NEW YORK NY
10016-8303
US

V. Phone/Fax

Practice location:
  • Phone: 646-370-2040
  • Fax: 646-370-2012
Mailing address:
  • Phone: 646-370-2040
  • Fax: 646-370-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number209035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: