Provider Demographics
NPI:1386059558
Name:WALTUCH, DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WALTUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1668
Mailing Address - Country:US
Mailing Address - Phone:973-684-1011
Mailing Address - Fax:973-684-4534
Practice Address - Street 1:265 E 33RD ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1668
Practice Address - Country:US
Practice Address - Phone:973-684-1011
Practice Address - Fax:973-684-4534
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006832-1213ES0103X
NJ25MD00335500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery