Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MB06525200 | NJ |
Y | 111NI0900X | Internist | 25MB06525200 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MB06525200 | NJ |
NPI | 1053310524 |
---|---|
Provider Name | Dr. Ehab Elias Tuppo |
First Address | Hawthorne, NJ 07506-2013 |
Second Address | Hawthorne, NJ 07506-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007412 | (05) | NJ |
H46439 | (02) | NJ |