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Individual

MR. CORY WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN, AGPCNP-BC

Contact information

Practice address
27 CLYDE RD STE 102, SOMERSET, NJ 08873-5039
(732) 246-0057
Mailing address
30 ULYSSES RD, SOMERSET, NJ 08873-1049
(973) 462-8797

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
26NR20435100
NJ
363L00000X
Nurse Practitioner
Primary
26NJ15461200
NJ

Other

Enumeration date
07/21/2022
Last updated
03/09/2026
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