Individual
JAMES M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 OFFICE PARK WAY, PITTSFORD, NY 14534
(505) 249-6220
(585) 586-5512
Mailing address
601 ELMWOOD AVE, BOX: PSYCH, ROCHESTER, NY 14642-0001
(505) 249-6220
(585) 276-0161
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
185559
NY
2084P0800X
Psychiatry Physician
Primary
185559-1
NY
2084P0804X
Child & Adolescent Psychiatry Physician
185559
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01685092
—
NY
01
—
EXCELLUS BCBS
2006
NY
01
—
PREFERRED CORE
102663EW
NY
Enumeration date
10/12/2006
Last updated
07/06/2023
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