David M Wallace
Gynecologist - Maternal & Fetal Medicine
73 S Bath Ave
Long Branch
, New Jersey 07740-5725
David M Wallace
Gynecologist - Maternal & Fetal Medicine
73 S Bath Ave
Long Branch
, New Jersey 07740-5725
(708) 342-2517
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About
Features
Specialties
- Gynecologist - Maternal & Fetal Medicine
Languages spoken
- English
Location
First Address
- David M Wallace
- Po Box 8000 Dept 596
- Buffalo, NY
- Zip : 14267-0002
- Fax : (708) 342-2517
- Phone : (866) 295-0041
Second Address
- David M Wallace
- 73 S Bath Ave
- Long Branch, NJ
- Zip : 07740-5725
- Fax : (732) 870-0119
- Phone : (732) 870-3600
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA04221200 | NJ |
National Provider Identifier
| NPI | 1336116656 |
|---|---|
| Provider Name | David M Wallace |
| First Address | Buffalo, NY 14267-0002 |
| Second Address | Long Branch, NJ 07740-5725 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/03/2006 |
| Last Update Date | 14/10/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2462907 | (05) | NJ |
| C28837 | (02) | NJ |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.