Basic Information
| Provider Information | |||||||||
| NPI: | 1578579322 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSEPH SAPONARO, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 KNUTH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334364693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 S OLD DIXIE HWY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 07/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | SAPONARO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617361200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 57414700 | 05 | FL | MEDICAID | DQ9715 | 01 | FL | RAILROAD MEDICARE | OTHER |