Individual
DR. JACOB WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
99 N BROADWAY, NYACK, NY 10960-2627
(845) 358-1728
Mailing address
99 N BROADWAY, NYACK, NY 10960-2627
(845) 358-1728
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50 053926
NY
Other
Enumeration date
08/01/2008
Last updated
08/04/2011
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