NPIMap

Organization Active NPI

PNC MSK, PC

  • Foot & Ankle Surgery Podiatrist
  • Santa Rosa, CA
National Provider Identifier
1356169593
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PNC MSK, PC
Practice address
1041 4TH St Ste B
Santa Rosa, CA 95404-4329
Phone
(707) 237-3410
NPI assigned
Sep 27, 2024
Organization subpart
Yes
Parent organization
PNC MSK, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alexander Reyzelman, DPM
Title
Rcmo
Phone
(415) 292-0638

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1041 4TH St Ste B
Santa Rosa, CA 95404-4329

Mailing address

1041 4TH St Ste B
Santa Rosa, CA 95404-4329
Phone (707) 237-3410

National Provider Directory

National Provider Directory
Tax ID family
PNC MSK PC2 organizations share this tax ID, including this one
Part of
PNC MSK PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1356169593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 4TH ST STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044329",
            "telephone_number": "707-237-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 4TH ST STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044329",
            "telephone_number": "707-237-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNC MSK, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PNC MSK, PC",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "REYZELMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "RCMO",
        "authorized_official_telephone_number": "415-292-0638",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.