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General NPI Number Information
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NPI Number | 1902355423
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Entity Type | Organization
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Legal Business Name | PREFERRED FOOT AND ANKLE CENTER PC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 4 ROSE AVE
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-4324
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Country | US
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Telephone | 215-355-7555
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Fax | 267-352-4032
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Provider Business Mailing Address
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Address Line | 4 ROSE AVE
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-4324
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Country | US
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Telephone | 215-355-7555
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Fax | 267-352-4032
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Authorized Official
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Title or Position | PODIATRIST
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Name | ELZA TYSHKO
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Credential | DPM
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Telephone | 215-355-7555
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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 | SC006504
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License Number State | PA
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