Provider Demographics
NPI:1073842068
Name:TIPPIT, RORY E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RORY
Middle Name:E
Last Name:TIPPIT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6749 E 16TH ST
Mailing Address - Street 2:21ST CST WMD
Mailing Address - City:FORT DIX
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-5709
Mailing Address - Country:US
Mailing Address - Phone:210-383-1934
Mailing Address - Fax:
Practice Address - Street 1:6749 E 16TH ST
Practice Address - Street 2:21ST CST WMD
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5709
Practice Address - Country:US
Practice Address - Phone:210-383-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00225700363A00000X
PAMA053978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant