Jenkins, Wallace Russell
Jenkins, Wallace Russell is an individual health care provider with primary practice located at 503 Grasslands Rd Ste 200, Valhalla NY 10595. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Jenkins, Wallace Russell can be contacted via phone (914) 304-5288.Contact Information
Primary practice address
503 Grasslands Rd Ste 200
Valhalla NY 10595
Phone: (914) 304-5288
Fax: (914) 345-1755
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 183800 | New York |
Profile Details
| NPI number | 1487654653 |
|---|---|
| LBN Legal business name | Jenkins, Wallace Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Jul 23rd, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487654653 | NPPES |
| New York | MEDICAID | 01210104 |
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