Healthcare Provider Details

I. General information

NPI: 1235156290
Provider Name (Legal Business Name): ELIEZER TRYBUCH DPM,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 NEW HAMPSHIRE AVENUE
SILVER SPRING MD
20904-2868
US

IV. Provider business mailing address

620 C ST SE
WASHINGTON DC
20003-4302
US

V. Phone/Fax

Practice location:
  • Phone: 301-622-3040
  • Fax: 301-622-0779
Mailing address:
  • Phone: 202-543-0035
  • Fax: 301-251-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP000430
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberP0295
License Number StateDC

VIII. Authorized Official

Name: DR. ELIEZER TRYBUCH
Title or Position: OWNER
Credential: DPM
Phone: 202-543-0035