Individual
JOHN A. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
702 W MAPLE AVE, MERCHANTVILLE, NJ 08109-1822
(856) 665-1180
(856) 665-5537
Mailing address
702 W MAPLE AVE, MERCHANTVILLE, NJ 08109-1822
(856) 665-1180
(856) 665-5537
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
MD00151900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0425672000
AMERIHEALTH
NJ
05
—
6574009
—
NJ
Enumeration date
07/10/2006
Last updated
07/08/2007
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