Provider Demographics
NPI:1346240215
Name:TUPPO, ENAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ENAS
Middle Name:
Last Name:TUPPO
Suffix:
Gender:F
Credentials:MD
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:HAWTHRONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506
Mailing Address - Country:US
Mailing Address - Phone:973-427-2421
Mailing Address - Fax:973-427-5892
Practice Address - Street 1:1083 GOFFLE ROAD
Practice Address - Street 2:
Practice Address - City:HAWTHRONE
Practice Address - State:NJ
Practice Address - Zip Code:07506
Practice Address - Country:US
Practice Address - Phone:973-427-2421
Practice Address - Fax:973-427-5892
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06463100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8238707Medicaid
NJG77773Medicare UPIN
NJ014978Medicare PIN