| NPI | 1770226755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER REYZELMAN Credentialing Manager 415-292-0638 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2024-06-26 |