Search › New Jersey › 1041S0200X
Lyle Wallace
NPI 1992444954 · on the registry since 2022 · sole proprietor
Practice
- Address
- 36 Walker Rd
West Orange, NJ 07052 - Phone
- (973) 715-5591
Registry record
- Primary taxonomy
- 1041S0200X
1041S0200X
- Licence states on file
- NJ
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-05-29
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