Healthcare Provider Details

I. General information

NPI: 1316564107
Provider Name (Legal Business Name): TYMOTEUSZ JAKUB SIWY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 1/2 FORREST AVE STE 1
NARBERTH PA
19072-2220
US

IV. Provider business mailing address

104 1/2 FORREST AVE STE 1
NARBERTH PA
19072-2220
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-1070
  • Fax: 610-664-6853
Mailing address:
  • Phone: 610-664-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007091
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: