1417912684 NPI number — DR. STEPHEN A SAPONARO MD

Table of content: DR. STEPHEN A SAPONARO MD (NPI 1417912684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417912684 NPI number — DR. STEPHEN A SAPONARO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAPONARO
Provider First Name:
STEPHEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417912684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39000 BOB HOPE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-3221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-636-6798
Provider Business Mailing Address Fax Number:
760-773-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 BOB HOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-636-6798
Provider Business Practice Location Address Fax Number:
760-773-1802
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD062393L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 26046 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25MA07614200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: G88603 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00971901 . This is a "RXR MCR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 001659570 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0434981000 . This is a "IBC KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00390756 . This is a "RRMC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 231955165 . This is a "INTERGROUP SERVICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231955165 . This is a "AETNA USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001659570 . This is a "AMERICHOICE OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016595700015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD062393L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7584 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0035875 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30033205 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200129230A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 966739 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00403740 . This is a "RRMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9445645 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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