Derrick I Wallace, MD
Derrick I Wallace, MD is an Otolaryngology in Nutley, New Jersey. Graduated from Icahn School of Medicine at Mount Sinai in 1996, 30 years ago. Practices with Summit Medical Group PA, a 1,205-clinician group and accepts Medicare assignment. Licensed in New Jersey and New York.
- Years since qualifying
- 30
- Trained at
- Icahn School of Medicine at Mount Sinai
- Licensed in
- NJ, NY
- In the registry since
- 2005
- Specialties on file
- 2
What do these letters mean?
- MD — Doctor of Medicine
- A physician who completed allopathic medical school.
Practice location Address checks out
187 Washington Ave Ste 2INutley, NJ 07110-3935
Phone: (973) 235-0090
Fax: (973) 235-0090
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Otolaryngology Physician (primary) | Taxonomy 207Y00000X · Licence 25MA08175200 (NJ) |
|---|---|
| Otolaryngology Physician | Taxonomy 207Y00000X · Licence 208988 (NY) |
Record details
| NPI number | 1114900362 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | MD |
| Sole proprietor | Yes |
| NPI enumerated | November 22, 2005 |
| Last updated in NPPES | November 29, 2011 |
| Mailing address | 187 Washinton Ave, Suite 2i, Nutley, NJ 07110-1980 |
Medicare enrollment
| Medicare specialty | OTOLARYNGOLOGY |
|---|---|
| Medical school | ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI |
| Graduated | 1996 (30 years in practice) |
| Group practice | Summit Medical Group Pa — 1205 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
Other providers in Nutley
-
Ear Nose and Throat Solutions of Nj
187 Washington Ave Ste 2I, Nutley, NJ 07110-3935 · (973) 235-0090
-
Ear, Nose & Throat Center of Nj
115 Franklin Ave, Nutley, NJ 07110-2924 · (973) 773-9250