Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA03949800 | NJ |
NPI | 1063516441 |
---|---|
Provider Name | John Lewis Saporito |
First Address | Shrewsbury, NJ 07702 |
Second Address | Shrewsbury, NJ 07702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 19/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56337 | (02) |