Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0103000360 | VA |
NPI | 1003809112 |
---|---|
Provider Name | Mr. Jay I Tischler |
First Address | Virginia Beach, VA 23454-2406 |
Second Address | Virginia Beach, VA 23454-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011560 | ANTHEM PROVIDER NUMBER (01) | VA |
15423 | OPTIMA PROVIDER NUMBER (01) | VA |
311651 | MDIPA MAMSI PROVIDER NUMB (01) | VA |
9301071 | (05) | VA |
T21387 | (02) | VA |