Individual
DR. CHARLES THOMAS WALLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
10 CHAPEL HILL RD, LINCOLN PARK, NJ 07035-1719
(973) 694-5632
Mailing address
10 CHAPEL HILL RD, LINCOLN PARK, NJ 07035-1719
(973) 694-5632
(973) 694-1233
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00140200
NJ
213ES0131X
Foot Surgery Podiatrist
25MD00140200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103711000
AMERIHEALTH
NJ
05
—
1376004-01
—
NJ
01
—
P3601404
OXFORD
NJ
Enumeration date
02/04/2006
Last updated
01/14/2010
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