Healthcare Provider Details

I. General information

NPI: 1871329375
Provider Name (Legal Business Name): PNC MSK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 WASHINGTON AVE STE A
UKIAH CA
95482-6319
US

IV. Provider business mailing address

PO BOX 33445
BELFAST ME
04915-0612
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-4136
  • Fax: 310-791-1087
Mailing address:
  • Phone: 415-645-4525
  • Fax: 510-399-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

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