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General NPI Number Information
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NPI Number | 1528910494
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Entity Type | Individual
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Provider Name | MICHELLE D. WALLACH
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Gender | Female
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 15 DELLWOOD LN
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City | SOMERSET
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State | NJ
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Zip | 08873-1551
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Country | US
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Telephone | 732-545-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WINCHESTER RD
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City | SUMMIT
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State | NJ
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Zip | 07901-3019
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Country | US
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Telephone | 917-406-8942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 46R00705000
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License Number State | NJ
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