Individual
EMMA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD/PHD
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 430-3166
Mailing address
43 WESTMINSTER AVE, BERGENFIELD, NJ 07621-3913
(201) 387-1957
(201) 351-0656
Taxonomy
Speciality
Code
Description
License number
State
2084V0102X
Vascular Neurology Physician
Primary
312463
NY
2085R0204X
Vascular & Interventional Radiology Physician
312463
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2017
Last updated
04/11/2022
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