Provider Demographics
NPI:1558516518
Name:JUAN, FELIPE TANSECO (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:TANSECO
Last Name:JUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 HAMBURG TPKE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8431
Mailing Address - Country:US
Mailing Address - Phone:973-595-8383
Mailing Address - Fax:973-595-0755
Practice Address - Street 1:502 HAMBURG TPKE
Practice Address - Street 2:SUITE 101A
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8431
Practice Address - Country:US
Practice Address - Phone:973-595-8383
Practice Address - Fax:973-595-0755
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ027260207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine