Provider Demographics
NPI:1770510307
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:PRESIDENT/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
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 1:421 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5442
Practice Address - Country:US
Practice Address - Phone:570-283-0220
Practice Address - Fax:570-283-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0505757Medicaid
PA0505757Medicaid
1137270001Medicare NSC