Provider Demographics
NPI:1588878300
Name:HAWTHORNE FAMILY PRACTICE
Entity type:Organization
Organization Name:HAWTHORNE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-427-2421
Mailing Address - Street 1:1083 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2025
Mailing Address - Country:US
Mailing Address - Phone:973-427-2421
Mailing Address - Fax:973-427-6205
Practice Address - Street 1:1083 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2025
Practice Address - Country:US
Practice Address - Phone:973-427-2421
Practice Address - Fax:973-427-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031095Medicare PIN