Healthcare Provider Details

I. General information

NPI: 1437054749
Provider Name (Legal Business Name): PNC PODIATRY OF WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SHERIDAN RD STE 101
BREMERTON WA
98310-2701
US

IV. Provider business mailing address

PO BOX 843324
LOS ANGELES CA
90084-3324
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CMO
Credential:
Phone: 415-680-0871