Provider Demographics
NPI:1316564107
Name:SIWY, TYMOTEUSZ JAKUB (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYMOTEUSZ
Middle Name:JAKUB
Last Name:SIWY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PHOENIXVILLE HOSPITAL
Mailing Address - Street 2:140 NUTT RD
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1903
Mailing Address - Country:US
Mailing Address - Phone:610-983-1421
Mailing Address - Fax:
Practice Address - Street 1:104 1/2 FORREST AVE STE 1
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2220
Practice Address - Country:US
Practice Address - Phone:610-664-1070
Practice Address - Fax:610-664-6853
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007091213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC007091OtherPA BOARD OF PODIATRY
PA32782554OtherDRIVER'S LICENSE