Provider Demographics
NPI:1518465020
Name:TIEVSKY PODIATRY, LLC
Entity Type:Organization
Organization Name:TIEVSKY PODIATRY, LLC
Other - Org Name:TIEVSKY FOOT & ANKLE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-666-7119
Mailing Address - Street 1:15-01 BROADWAY STE 10B
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6006
Mailing Address - Country:US
Mailing Address - Phone:833-439-3668
Mailing Address - Fax:201-537-6910
Practice Address - Street 1:15-01 BROADWAY STE 10B
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6006
Practice Address - Country:US
Practice Address - Phone:833-439-3668
Practice Address - Fax:201-537-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00321200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty