Provider Demographics
NPI:1326023151
Name:QUIRK, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:QUIRK
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 1:9 OLMSTED LN
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-4205
Mailing Address - Country:US
Mailing Address - Phone:215-264-1926
Mailing Address - Fax:
Practice Address - Street 1:5034 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2022
Practice Address - Country:US
Practice Address - Phone:215-728-3714
Practice Address - Fax:215-728-3923
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09865300207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011383110002Medicaid
PA0011383110002Medicaid
E51877Medicare UPIN