Provider Demographics
NPI:1679650683
Name:WALLACK, MARC KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:KENNETH
Last Name:WALLACK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 1ST AVE
Mailing Address - Street 2:RM 12A1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7404
Mailing Address - Country:US
Mailing Address - Phone:212-423-6614
Mailing Address - Fax:212-423-7913
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:RM 12A1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6614
Practice Address - Fax:212-423-7913
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1851182086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology