Wallack, Charles Thomas

Wallack, Charles Thomas is an sole proprietor health care provider with primary practice located at 10 Chapel Hill Rd , Lincoln Park NJ 07035-1719. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Wallack, Charles Thomas can be contacted via phone (973) 694-5632.

Contact Information

Primary practice address
10 Chapel Hill Rd Lincoln Park NJ 07035-1719
Phone: (973) 694-5632
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 25MD00140200 New Jersey
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 25MD00140200 New Jersey

Profile Details

NPI number 1265404198
LBN Legal business name Wallack, Charles Thomas
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 4th, 2006
Last updated Jan 14th, 2010 - about 16 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 1265404198 NPPES
New Jersey Other 0103711000 AMERIHEALTH
New Jersey MEDICAID 1376004-01 AMERIHEALTH
New Jersey Other P3601404 AMERIHEALTH

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