MEDICARE: DR. EHAB ELIAS TUPPO DO

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	25MB06525200	NJ
2	207R00000X	Internal Medicine Physician	25MB06525200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053310524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHAB ELIAS TUPPO DO

Provider Business Mailing Address
First Line	:	1083 GOFFLE RD
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2013
Country	:	US
Telephone Number	:	973-427-2421
Fax Number	:	973-427-6205

Provider Business Practice Location Address
First Line	:	1083 GOFFLE RD
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2013
Country	:	US
Telephone Number	:	973-427-2421
Fax Number	:	973-427-6205

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/17/2021

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