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Individual

STEPHEN G WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
350 YOUNG AVE STE 200, MOORESTOWN, NJ 08057-3146
(609) 702-1900
(609) 702-8455
Mailing address
25 MAIN ST STE 601, HACKENSACK, NJ 07601-7083
(609) 702-1900
(609) 702-8455

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MA079166
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0068837
NJ
01
3982071
AETNA
Enumeration date
07/12/2006
Last updated
10/19/2021
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