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General NPI Number Information
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NPI Number | 1003809112
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Entity Type | Individual
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Provider Name | JAY I TISCHLER DPM
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 1080 FIRST COLONIAL RD STE 400
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2406
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Country | US
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Telephone | 757-395-1880
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Fax | 757-431-7770
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Provider Business Mailing Address
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Address Line | 1080 FIRST COLONIAL RD STE 400
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2406
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Country | US
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Telephone | 757-395-1880
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Fax | 757-431-7770
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103000360
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License Number State | VA
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