Individual
DR. JACOB WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2424 KINGS HWY, STE 1G, BROOKLYN, NY 11229-1641
(718) 258-9572
(718) 258-7216
Mailing address
51 WHITE DR, CEDARHURST, NY 11516-2630
(718) 258-9572
(718) 258-7216
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
N005523
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02059272
—
NY
Enumeration date
08/21/2006
Last updated
01/02/2022
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