Healthcare Provider Details

I. General information

NPI: 1770510307
Provider Name (Legal Business Name): WYOMING VALLEY FOOT ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MARKET ST
KINGSTON PA
18704-5442
US

IV. Provider business mailing address

421 MARKET ST
KINGSTON PA
18704-5418
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-0220
  • Fax: 570-283-1707
Mailing address:
  • Phone: 570-283-0220
  • Fax: 570-283-1707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH M TOOLE
Title or Position: PRESIDENT/ AUTHORIZED OFFICIAL
Credential: DPM
Phone: 570-283-0220