Wallace, David M

Wallace, David M is an individual health care provider with primary practice located at 73 S Bath Ave , Long Branch NJ 07740-5725. He recently has only one registered license in Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine, which is considered as his primary health care specialty. Wallace, David M can be contacted via phone (732) 870-3600.

Contact Information

Primary practice address
73 S Bath Ave Long Branch NJ 07740-5725
Phone: (732) 870-3600
Fax: (732) 870-0119
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine 207VM0101X 25MA04221200 New Jersey

Profile Details

NPI number 1336116656
LBN Legal business name Wallace, David M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 6th, 2006
Last updated Oct 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336116656 NPPES
New Jersey MEDICAID 2462907

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