Provider Demographics
NPI:1538646591
Name:WYOMING VALLEY FOOT ASSOCIATES P C
Entity Type:Organization
Organization Name:WYOMING VALLEY FOOT ASSOCIATES P C
Other - Org Name:DR LEON A ELLMAN, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-283-0220
Mailing Address - Street 1:421 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5418
Mailing Address - Country:US
Mailing Address - Phone:570-283-0220
Mailing Address - Fax:570-283-1707
Practice Address - Street 1:457 N MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2185
Practice Address - Country:US
Practice Address - Phone:570-299-2953
Practice Address - Fax:570-569-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002926L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty