Provider Demographics
NPI:1477878205
Name:TUTELA, JOHN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
Last Name:TUTELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 60TH ST
Mailing Address - Street 2:SUITE AN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7902
Mailing Address - Country:US
Mailing Address - Phone:917-912-1677
Mailing Address - Fax:
Practice Address - Street 1:30 W 60TH ST
Practice Address - Street 2:SUITE AN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7902
Practice Address - Country:US
Practice Address - Phone:917-912-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252127208200000X
NJ25MA09369900208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery