Provider Demographics
NPI:1538037007
Name:PNC PODIATRY OF WASHINGTON PLLC
Entity type:Organization
Organization Name:PNC PODIATRY OF WASHINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
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 36326
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1205
Mailing Address - Country:US
Mailing Address - Phone:425-822-7426
Mailing Address - Fax:425-827-1717
Practice Address - Street 1:3236 78TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3500
Practice Address - Country:US
Practice Address - Phone:425-822-7426
Practice Address - Fax:425-827-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty