=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790484509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY PODIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2023
-----------------------------------------------------
Last Update Date | 03/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 KATONAH AVE
-----------------------------------------------------
City | KATONAH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10536-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-3392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 ROUTE 6 AND 209
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18337-9424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-3392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MARK FRANKEL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 973-534-3392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------