Provider Demographics
NPI:1053310524
Name:TUPPO, EHAB ELIAS (DO)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:ELIAS
Last Name:TUPPO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2013
Mailing Address - Country:US
Mailing Address - Phone:973-427-2421
Mailing Address - Fax:973-427-6205
Practice Address - Street 1:1083 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2013
Practice Address - Country:US
Practice Address - Phone:973-427-2421
Practice Address - Fax:973-427-6205
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06525200207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0007412Medicaid
NJ071363Medicare PIN
NJ0007412Medicaid