Individual
ZICHARIEA Z WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1000 N VILLAGE AVE., MERCY MEDICAL CENTER, ROCKVILLE CENTRE, NY 11570
(516) 705-2525
(516) 705-6969
Mailing address
1003 STEELE BLVD, BALDWIN, NY 11510-4444
(718) 367-0200
(718) 367-0222
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
010776
NY
Other
Enumeration date
10/13/2006
Last updated
10/10/2011
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