Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MD001684 | NJ |
Y | 222Z00000X | Podiatrist | MD001684 | NJ |
NPI | 1003862970 |
---|---|
Provider Name | Mark Tirone |
First Address | Collingswood, NJ 08108-1121 |
Second Address | Collingswood, NJ 08108-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0623008 | (05) | NJ |
T84914 | (02) |