Provider Demographics
NPI:1245519354
Name:TJOE, EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:TJOE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 YORK ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3838
Mailing Address - Country:US
Mailing Address - Phone:201-984-0231
Mailing Address - Fax:201-918-5377
Practice Address - Street 1:66 YORK ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3838
Practice Address - Country:US
Practice Address - Phone:201-984-0231
Practice Address - Fax:201-918-5377
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00310500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ228859Medicare PIN