Provider Demographics
NPI:1538587563
Name:LAPORTA, JENNIFER ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:LAPORTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:766 SHREWSBURY AVE BLDG SUITE101
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3001
Mailing Address - Country:US
Mailing Address - Phone:732-945-2009
Mailing Address - Fax:732-747-8697
Practice Address - Street 1:766 SHREWSBURY AVE BLDG SUITE101
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3001
Practice Address - Country:US
Practice Address - Phone:732-945-2009
Practice Address - Fax:732-747-8697
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10005700207Q00000X
NY287545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04782743Medicaid
NJ0685984Medicaid
NJ823848OtherMEDICARE
NYA400174459OtherMEDICARE