Individual
BRUCE HARRIS WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34-36 PROGRESS ST., SUITE B-2, EDISON, NJ 08820
(908) 757-9696
(908) 757-9721
Mailing address
629 CRANBURY RD FL 2, EAST BRUNSWICK, NJ 08816-4096
(732) 390-7750
(732) 390-7725
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
207RH0003X
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790396281
TITAN HEALTH GROUP NPI#
NJ
01
—
751594CTK
MEDICAREID
NJ
05
—
7534809
—
NJ
Enumeration date
12/17/2005
Last updated
05/20/2023
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