Individual
THERESA C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
95 MADISON AVE, SUITE 101, MORRISTOWN, NJ 07960
(973) 267-1010
(973) 267-5521
Mailing address
95 MADISON AVE, SUITE 101, MORRISTOWN, NJ 07960
(973) 267-1010
(973) 267-5521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA0616800
NJ
Other
Enumeration date
05/26/2006
Last updated
07/08/2007
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