Provider Demographics
NPI:1902355423
Name:PREFERRED FOOT AND ANKLE CENTER PC
Entity Type:Organization
Organization Name:PREFERRED FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ELZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-355-7555
Mailing Address - Street 1:4 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4324
Mailing Address - Country:US
Mailing Address - Phone:215-355-7555
Mailing Address - Fax:267-352-4032
Practice Address - Street 1:4 ROSE AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4324
Practice Address - Country:US
Practice Address - Phone:215-355-7555
Practice Address - Fax:267-352-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006504213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty