Provider Demographics
NPI:1871329375
Name:PNC MSK, PC
Entity type:Organization
Organization Name:PNC MSK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCMO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-292-0638
Mailing Address - Street 1:PO BOX 33445
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0612
Mailing Address - Country:US
Mailing Address - Phone:415-645-4525
Mailing Address - Fax:510-399-1364
Practice Address - Street 1:172 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6319
Practice Address - Country:US
Practice Address - Phone:707-462-4136
Practice Address - Fax:310-791-1087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PNC MSK, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies