Healthcare Provider Details

I. General information

NPI: 1508922139
Provider Name (Legal Business Name): DONALD JAMES PYSKATY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1441 BUCHANAN ST
NOVATO CA
94947-4487
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7592
  • Fax:
Mailing address:
  • Phone: 415-497-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG 80237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: