Healthcare Provider Details

I. General information

NPI: 1114101110
Provider Name (Legal Business Name): VALLEY PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WILLIMANSETT ST
SOUTH HADLEY MA
01075-3000
US

IV. Provider business mailing address

PO BOX 10417
HOLYOKE MA
01041-2017
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-0912
  • Fax:
Mailing address:
  • Phone: 413-540-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1786
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER WOLF
Title or Position: OWNER
Credential: DPM
Phone: 413-536-0289