Provider Demographics
NPI:1639835267
Name:ALEXANDER REYZELMAN, DPM, INC.
Entity Type:Organization
Organization Name:ALEXANDER REYZELMAN, DPM, INC.
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 1:2299 POST ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3473
Mailing Address - Country:US
Mailing Address - Phone:415-292-0638
Mailing Address - Fax:855-621-1883
Practice Address - Street 1:1720 MARCO POLO WAY STE A
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4513
Practice Address - Country:US
Practice Address - Phone:650-692-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXANDER REYZELMAN, DPM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty