Provider Demographics
NPI:1609047836
Name:ROBERT C TYRRELL, DPM
Entity Type:Organization
Organization Name:ROBERT C TYRRELL, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-663-3733
Mailing Address - Street 1:44 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2314
Mailing Address - Country:US
Mailing Address - Phone:856-663-3733
Mailing Address - Fax:856-663-3660
Practice Address - Street 1:706 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2652
Practice Address - Country:US
Practice Address - Phone:856-663-3733
Practice Address - Fax:856-663-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT C TYRRELL, DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD2500180000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0536570001Medicare NSC