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Individual
DR. CHARLES THOMAS WALLACK
Active
Individual
DR. CHARLES THOMAS WALLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00140200
NJ
213ES0131X
Foot Surgery Podiatrist
25MD00140200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103711000
AMERIHEALTH
NJ
05
—
1376004-01
—
NJ
01
—
P3601404
OXFORD
NJ
Enumeration date
02/04/2006
Last updated
01/14/2010
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