Provider Demographics
NPI:1578714507
Name:BAKOSI, EBUBE A (MD)
Entity Type:Individual
Prefix:DR
First Name:EBUBE
Middle Name:A
Last Name:BAKOSI
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:287 BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1726
Practice Address - Country:US
Practice Address - Phone:973-839-7400
Practice Address - Fax:973-831-4911
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445723204F00000X, 208600000X
NJ25MA09042500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery