Individual
DR. MARK EDWARD WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
77 7TH AVE, #19D, NEW YORK, NY 10011-6645
(212) 675-8586
Mailing address
77 7TH AVE, #19D, NEW YORK, NY 10011-6645
(212) 675-8586
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
160946
NY
Other
Enumeration date
01/18/2012
Last updated
01/18/2012
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