Dr. Charles Thomas Wallack
Podiatrist Foot Surgery
10 Chapel Hill Rd
Lincoln Park
, New Jersey 07035-1719
Dr. Charles Thomas Wallack
Podiatrist Foot Surgery
10 Chapel Hill Rd
Lincoln Park
, New Jersey 07035-1719
(973) 694-1233
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About
Features
Specialties
- Podiatrist
- Foot Surgery
Languages spoken
- English
Location
First Address
- Dr. Charles Thomas Wallack
- 10 Chapel Hill Rd
- Lincoln Park, NJ
- Zip : 07035-1719
- Fax : (973) 694-1233
- Phone : (973) 694-5632
Second Address
- Dr. Charles Thomas Wallack
- 10 Chapel Hill Rd
- Lincoln Park, NJ
- Zip : 07035-1719
- Phone : (973) 694-5632
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 25MD00140200 | NJ |
| Y | 222Z00000X | Podiatrist | 25MD00140200 | NJ |
| N | 213ES0131X | Foot Surgery | 25MD00140200 | NJ |
National Provider Identifier
| NPI | 1265404198 |
|---|---|
| Provider Name | Dr. Charles Thomas Wallack |
| First Address | Lincoln Park, NJ 07035-1719 |
| Second Address | Lincoln Park, NJ 07035-1719 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/02/2006 |
| Last Update Date | 14/01/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0103711000 | AMERIHEALTH (01) | NJ |
| 1376004-01 | (05) | NJ |
| P3601404 | OXFORD (01) | NJ |
| T45204 | (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.