Provider Demographics
NPI:1063516441
Name:SAPORITO, JOHN LEWIS (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LEWIS
Last Name:SAPORITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 BROAD STREET
Mailing Address - Street 2:STE 102
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-389-2500
Mailing Address - Fax:732-389-2820
Practice Address - Street 1:1131 BROAD STREET
Practice Address - Street 2:STE 102
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-389-2500
Practice Address - Fax:732-389-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03949800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ465257MDFMedicare ID - Type Unspecified
C56337Medicare UPIN