Provider Demographics
NPI:1235156290
Name:ELIEZER TRYBUCH DPM,LLC
Entity Type:Organization
Organization Name:ELIEZER TRYBUCH DPM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-543-0035
Mailing Address - Street 1:620 C ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4302
Mailing Address - Country:US
Mailing Address - Phone:202-543-0035
Mailing Address - Fax:301-251-2138
Practice Address - Street 1:12121 NEW HAMPSHIRE AVENUE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2868
Practice Address - Country:US
Practice Address - Phone:301-622-3040
Practice Address - Fax:301-622-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP000430213E00000X
DCP0295213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011323100Medicaid
MD5459450001Medicare NSC
DC011323100Medicaid