MEDICARE: DR. EBUBE A. BAKOSI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204F00000X	Transplant Surgery Physician	MD445723	PA
2	208600000X	Surgery Physician	25MA09042500	NJ
3	208600000X	Surgery Physician	MD445723	PA

General Provider Information

NPI Number	:	1578714507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBUBE A. BAKOSI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	973-656-6280
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	287 BOULEVARD
Second Line	:	SUITE 1
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1726
Country	:	US
Telephone Number	:	973-839-7400
Fax Number	:	973-831-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	05/06/2015

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