Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. CHARLES THOMAS WALLACK, D.P.M.
Active Sole ProprietorDR. CHARLES THOMAS WALLACK, D.P.M. is a Podiatrist healthcare provider located in LINCOLN PARK, New Jersey. NPI 1265404198 is currently active in the NPPES registry. Verify at CMS.
Podiatrist · LINCOLN PARK, NJ
Registration Details
- NPI Number
- 1265404198
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 4, 2006 (20.51009649641 yrs)
- Last Updated
- Jan 14, 2010
- Licenses
-
25MD00140200 (NJ)25MD00140200 (NJ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
10 CHAPEL HILL RDLINCOLN PARK, NJ, 070351719Browse NJ providers · Browse ZIP 07035
- Phone
- 9736945632
- Primary Specialty
-
Podiatrist
213E00000X
- Additional Specialty
- Foot Surgery Podiatrist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.