Provider Demographics
NPI:1316387608
Name:TYSHKO, ELZA (DPM)
Entity Type:Individual
Prefix:
First Name:ELZA
Middle Name:
Last Name:TYSHKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4324
Mailing Address - Country:US
Mailing Address - Phone:215-355-7555
Mailing Address - Fax:267-352-4032
Practice Address - Street 1:4 ROSE AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4324
Practice Address - Country:US
Practice Address - Phone:267-991-6000
Practice Address - Fax:267-352-4032
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006504213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA532734ZWRWMedicare PIN