Provider Demographics
NPI:1447389937
Name:TECSON, FLOR TUPAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FLOR
Middle Name:TUPAZ
Last Name:TECSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FLOR
Other - Middle Name:TUPAZ
Other - Last Name:TECSON-TUMANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:355 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2460
Mailing Address - Country:US
Mailing Address - Phone:973-762-1073
Mailing Address - Fax:973-762-1073
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-921-9321
Practice Address - Fax:973-921-9323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47800Medicare UPIN
NJ097102Medicare PIN