DR. Charles Thomas Wallack, D.P.M.

NPI #1265404198 in Lincoln Park, New Jersey

Provider Information

NPI Number: 1265404198
Entity Type: Individual
Name: DR. Charles Thomas Wallack, D.P.M.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Podiatrist
Credential: D.P.M.
Enumeration Date: Feb 4, 2006
Last Updated: Jan 14, 2010

Practice Location

Address: 10 CHAPEL HILL RD
City: Lincoln Park
State: New Jersey
ZIP Code: 07035-1719
Phone: (973) 694-5632

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist	213E00000X	Primary
Podiatrist - Foot Surgery — Foot Surgery	213ES0131X

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