Organization
EAR NOSE AND THROAT SOLUTIONS OF NJ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK I WALLACE MD (MANAGING PARTNER)
(973) 235-0095
Entity
Organization
Contact information
Practice address
187 WASHINGTON AVE, SUITE 2I, NUTLEY, NJ 07110-3935
(973) 235-0090
(973) 995-1145
Mailing address
187 WASHINGTON AVE, SUITE 2I, NUTLEY, NJ 07110-3935
(973) 235-0090
(973) 995-1145
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MA08175200
NJ
Other
Enumeration date
11/17/2011
Last updated
02/15/2012
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