Derrick I. Wallace, M.D.
Otolaryngology (ENT) · Nutley, NJ
UnclaimedM.D.NPI 1114900362
- Primary taxonomy
- 207Y00000X
- Enumerated
- 2005-11-22
- Practice location
- Nutley, NJ
- Last NPPES update
- 2011-11-29
State licenses
- NJ · Physician · NPPES self-reportedListed on NPI record
- NY · Physician · NPPES self-reportedListed on NPI record
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.