Provider Demographics
NPI:1336469790
Name:ALEXANDER REYZELMAN D P M INC
Entity Type:Organization
Organization Name:ALEXANDER REYZELMAN D P M INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-680-0871
Mailing Address - Street 1:2299 POST ST
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3441
Mailing Address - Country:US
Mailing Address - Phone:415-292-0638
Mailing Address - Fax:415-292-0718
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:STE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3441
Practice Address - Country:US
Practice Address - Phone:415-292-0638
Practice Address - Fax:855-621-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4136213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41360Medicaid
CA000E41360Medicaid
CA4354810001Medicare NSC
CA000E41360Medicare PIN