George Wallace, D.P.M

NPI 1811001696 · on the registry since 2006

Practice

Address: 90 Bergen St
Doc 4500
Newark, NJ 07103
Phone: (973) 972-2500
Fax: (973) 972-2510
Organisation at this address: Special Llc
Siddhivinayak Inc
Siddhivinayak Inc
Clinical Practice Pc
Umdnj University Hospital
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 257

Registry record

Primary taxonomy: 213ES0103X
213ES0103X
Licence states on file: NJ
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2009-08-26

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New Jersey