Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI01305800 | NJ |
Y | 213EG0000X | General Practice | 22DI01305800 | NJ |
NPI | 1982626313 |
---|---|
Provider Name | Dr. Edward Michael Tirpack II |
First Address | Sparta, NJ 07871-3512 |
Second Address | Sparta, NJ 07871-3512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |