Provider Demographics
NPI:1962812842
Name:TUTELA PLASTIC SURGERY PA
Entity type:Organization
Organization Name:TUTELA PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN PAUL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TUTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-359-1034
Mailing Address - Street 1:347 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2744
Mailing Address - Country:US
Mailing Address - Phone:973-727-9275
Mailing Address - Fax:973-629-1707
Practice Address - Street 1:347 MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2744
Practice Address - Country:US
Practice Address - Phone:973-727-9275
Practice Address - Fax:973-629-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09369900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty