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General NPI Number Information
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NPI Number | 1316815889
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Entity Type | Organization
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Legal Business Name | PNC PODIATRY OF WASHINGTON PLLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 16030 BOTHELL EVERETT HWY STE 160
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City | MILL CREEK
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State | WA
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Zip | 98012-1794
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Country | US
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Telephone | 425-537-3777
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Fax | 425-407-5502
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Provider Business Mailing Address
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Address Line | PO BOX 36326
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City | BELFAST
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State | ME
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Zip | 04915-1205
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Country | US
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Telephone | 425-537-3777
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Fax | 425-407-5502
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Authorized Official
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Title or Position | CMO
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Name | ALEXANDER REYZELMAN
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Credential | DPM
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Telephone | 415-292-0638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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