BRIAN J WALLACE (NPI# 1427248350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427248350 |
| Entity Type | Individual |
| Full Name | BRIAN J WALLACE |
| Credential | PA |
| Practice Address |
325 Princeton Ave Princeton NJ 08540-1617 |
| Practice Telephone | 6099248131 |
| Practice Fax Number | 6099248532 |
| Mailing Telephone | 6099248131 |
| Mailing Fax Number | 6099248532 |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 25MP00183300 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | MEDICAL LICENSE | 25MP00183300 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093866121 | Brian Wallace | Dentist | 781 S Lake Dr, Suite 1, Prestonsburg, KY 41653-1340 | 2007-01-16 |
| 1801864350 | Brian Wallace | Internal Medicine | 9005 Kilbride Rd, Baltimore, MD 21236-2017 | 2006-03-10 |
| 1831198811 | Brian David Wallace | Radiology | 1100 Brookhaven Rd, Franklin, KY 42134-2746 | 2005-07-20 |
| 1861939845 | Brian Wallace | Counselor | 7907 Ostrow St Ste F, San Diego, CA 92111-3635 | 2017-01-27 |
| 1114378759 | Brian Charles Wallace | Physician Assistant | 125 W Catawba Ave, Mount Holly, NC 28120-1601 | 2016-06-24 |
| 1154677359 | Brian Venson Wallace | Physical Therapist | 711 Avignon Dr, Ridgeland, MS 39157-5120 | 2012-07-25 |
| 1598083495 | Brian William Wallace | Chiropractor | 139 Morristown Rd, Bernardsville, NJ 07924-2633 | 2010-05-17 |
| 1790017028 | Brian Edward Wallace | Anesthesiology | 400 E Pioneer Ave, Suite 101, Puyallup, WA 98372-3255 | 2010-02-11 |
| 1518118462 | Brian Robert Wallace | Orthopaedic Surgery | 1250 Pine Ridge Rd, Suite 203, Naples, FL 34108-8913 | 2008-10-08 |
| 1518124627 | Brian Scott Wallace | Emergency Medicine | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2008-05-18 |
| Street Address |
325 PRINCETON AVE |
| City | PRINCETON |
| State | NJ |
| Zip Code | 08540-1617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710960570 | Michael Alberto Palmer | Neuromusculoskeletal Medicine, Sports Medicine | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2005-11-25 |
| 1437756350 | Olivia N Dudley | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-10-04 |
| 1245843200 | Rebecca L Graessle | Physical Therapist | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-08-28 |
| 1972114700 | Kayla Roca | Physical Therapist | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-08-14 |
| 1952919417 | Madelyn L Schwartz | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-07-21 |
| 1568024214 | Melissa Kate Peyser | Occupational Therapist | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2019-07-02 |
| 1700447083 | Bridget Katherine Doolittle | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2019-06-26 |
| 1659840023 | Adam Abel | Physical Therapy Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2018-11-15 |
| 1942777842 | Sakina Mustafa Tayebali | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2018-10-29 |
| 1346725173 | Ryan Field | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2018-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420613 | Samantha Beatriz Manzano | Pharmacist | 301 N Harrison Street, Princeton, NJ 08540 | 2020-09-01 |
| 1306485768 | Allies, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 414 Freedom Blvd, Princeton, NJ 08540 | 2020-01-03 |
| 1124667589 | Allies, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 415 Freedom Blvd, Princeton, NJ 08540 | 2020-01-03 |
| 1215576673 | Allies, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 416 Freedom Blvd, Princeton, NJ 08540 | 2020-01-03 |
| 1508405929 | Allies, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 411 Freedom Blvd, Princeton, NJ 08540 | 2020-01-02 |
| 1992369698 | Suzanne Haggerty | Social Worker | 716 Executive Drive, Princeton, NJ 08540 | 2019-04-28 |
| 1700349552 | Pdp Associates LLC | Social Worker | 3490 Us Highway 1, Building 16 Suite 112, Princeton, NJ 08540 | 2019-04-09 |
| 1245722438 | Kyle Bonner | Social Worker | 166 Bunn Dr Ste 105, Princeton, NJ 08540 | 2018-06-04 |
| 1942700125 | Lifetouch Behavioral Health, LLC | Community/Behavioral Health | 112 Commons Way, Building 1, Suite 112, Princeton, NJ 08540 | 2018-02-14 |
| 1912407271 | Princeton Psychiatry & Consulting, LLC | Psychiatry & Neurology | 601 Ewing St, Suite C-10, Princeton, NJ 08540 | 2018-02-13 |
| Find all providers in zip 08540 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205464724 | Shraddha S Patel | Physician Assistant | 29 Goldstar Dr, Princeton, NJ 08540-8578 | 2020-03-30 |
| 1538702154 | Sahara Stanley | Physician Assistant | 104 Mahood Ave, Princeton, WV 24740-2617 | 2019-10-27 |
| 1205210853 | Homer K Lester | Physician Assistant | 112 12th St, Princeton, WV 24740-2312 | 2015-07-14 |
| 1285039420 | Deaconess Clinic, Inc. | Physician Assistant | 1414 W Broadway St, Princeton, IN 47670-1142 | 2014-10-30 |
| 1154738839 | Brittany Hope Jewell | Physician Assistant | 508 New Hope Rd Ste 102, Princeton, WV 24740-2265 | 2014-07-15 |
| 1861638561 | Adeyemi Babatunde Williams | Physician Assistant | 60 Hoover Ave, Princeton, NJ 08540-4639 | 2008-12-30 |
| 1184793556 | Joseph Harold Thornton | Physician Assistant | Princeton University Health, Mccosh Health Center, Princeton, NJ 08544-0001 | 2006-11-07 |
| 1104919828 | Leah D Petrunger | Physician Assistant | 150 Misty Lane, Princeton, WV 24740 | 2006-10-02 |
| 1437756350 | Olivia N Dudley | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-10-04 |
| 1952919417 | Madelyn L Schwartz | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-07-21 |
| Find all providers in PRINCETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.