IndividualActive
Derrick Wallace, M.D.
NPI 1114900362 · Otolaryngology Physician · Nutley, NJ
Provider details
- NPI number
- 1114900362
- Entity type
- Individual
- Primary specialty
- Otolaryngology PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 208988 (NY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
187 Washington Ave
Suite 2i
Nutley, NJ 07110-3935
Phone: (973) 235-0090
Fax: (973) 235-0090
Approximate (ZIP-level) locationGet directions
Mailing address
187 Washinton Ave
Nutley, NJ 07110-1980
Registry dates
- Enumerated
- 2005-11-22
- Last updated
- 2011-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.