Healthcare Provider Details

I. General information

NPI: 1639835267
Provider Name (Legal Business Name): ALEXANDER REYZELMAN, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MARCO POLO WAY STE A
BURLINGAME CA
94010-4513
US

IV. Provider business mailing address

2299 POST ST STE 205
SAN FRANCISCO CA
94115-3473
US

V. Phone/Fax

Practice location:
  • Phone: 650-692-4778
  • Fax:
Mailing address:
  • Phone: 415-292-0638
  • Fax: 855-621-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CMO
Credential: DPM
Phone: 415-292-0638