Organization
ASSOC. OF MAPLE PODIATRY,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A WALLACE DPM (OWNER)
(856) 665-1180
Entity
Organization
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
213E00000X
Podiatrist
Primary
MD00151900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037575
—
NJ
01
—
0078854000
AMERIHEALTH
NJ
01
—
60008976
HORIZON NJ HEALTH
NJ
Enumeration date
06/01/2006
Last updated
07/01/2009
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