1912906561 NPI number — DR. ROBERT CHRISTOPHER TYRRELL DPM

Table of content: DR. ROBERT CHRISTOPHER TYRRELL DPM (NPI 1912906561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912906561 NPI number — DR. ROBERT CHRISTOPHER TYRRELL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYRRELL
Provider First Name:
ROBERT
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912906561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 MELROSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADDON TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-869-0202
Provider Business Mailing Address Fax Number:
856-869-8159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 CHAPEL AVE W STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-663-3733
Provider Business Practice Location Address Fax Number:
856-663-3660
Provider Enumeration Date:
07/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  25MD00180000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0114943000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 441295 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0928309 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: E34136 . This is a "AMERIHEALTH ADMINITRATORS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1189506 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2232722520 . This is a "HORIZON BLUE SHIELD NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000534136 . This is a "HIGHMARK BLUE SHIELD PA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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