Provider Demographics
NPI:1467252023
Name:TYRRELL, MICHAEL SR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TYRRELL
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MANHASSET TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1133
Mailing Address - Country:US
Mailing Address - Phone:609-442-8411
Mailing Address - Fax:
Practice Address - Street 1:114 MANHASSET TRL
Practice Address - Street 2:
Practice Address - City:MEDFORD LAKES
Practice Address - State:NJ
Practice Address - Zip Code:08055-1133
Practice Address - Country:US
Practice Address - Phone:609-442-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health