MEDICARE: OLD TAPPAN MEDICAL GROUP, PA

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	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3695	OTHER	AETNA CAPITATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	087710	OTHER	AETNA CAPITATION NUMBER

General Provider Information

NPI Number	:	1912916693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD TAPPAN MEDICAL GROUP, PA

Provider Business Mailing Address
First Line	:	215 OLD TAPPAN RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7000
Country	:	US
Telephone Number	:	201-666-1000
Fax Number	:	201-666-7610

Provider Business Practice Location Address
First Line	:	215 OLD TAPPAN RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7000
Country	:	US
Telephone Number	:	201-666-1000
Fax Number	:	201-666-7610

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN G VARHOL
Credential	:	M.D.
Telephone Number	:	201-666-1000

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	09/11/2025

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Directions to “OLD TAPPAN MEDICAL GROUP, PA ” Practice Location

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