Provider Demographics
NPI:1861721300
Name:VALLEY PODIATRY ASSOCIATES PC
Entity type:Organization
Organization Name:VALLEY PODIATRY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DMP
Authorized Official - Phone:413-682-0031
Mailing Address - Street 1:PO BOX 10417
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-2017
Mailing Address - Country:US
Mailing Address - Phone:413-540-0150
Mailing Address - Fax:413-540-0159
Practice Address - Street 1:95 POST OFFICE PARK
Practice Address - Street 2:SUITE 9525
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1248
Practice Address - Country:US
Practice Address - Phone:413-682-0031
Practice Address - Fax:413-682-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1786213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1171170002Medicare NSC