Provider Demographics
NPI:1205088572
Name:TISHUK, PAVEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:TISHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HIGH ST
Mailing Address - Street 2:STE 1200
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9601
Mailing Address - Country:US
Mailing Address - Phone:732-771-3335
Mailing Address - Fax:
Practice Address - Street 1:183 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9601
Practice Address - Country:US
Practice Address - Phone:973-300-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA088259002084N0400X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine