| Imtiaz A. Mallick Physician P.c | |
|
798 Route 9 Fishkill NY 12524-1393 | |
| (845) 896-2204 | |
| (845) 896-5173 |
| Full Name | Imtiaz A. Mallick Physician P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 798 Route 9, Fishkill, New York |
| Authorized Official Name and Position | Imtiaz A Mallick (PRESIDENT & CEO) |
| Authorized Official Contact | 8458962204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imtiaz A. Mallick Physician P.c 798 Route 9 Fishkill NY 12524-1393 Ph: (845) 896-2204 | Imtiaz A. Mallick Physician P.c 798 Route 9 Fishkill NY 12524-1393 Ph: (845) 896-2204 |
| NPI Number | 1083946792 |
|---|---|
| Provider Enumeration Date | 02/04/2010 |
| Last Update Date | 03/05/2022 |
| Medicare PECOS PAC ID | 9234325861 |
|---|---|
| Medicare Enrollment ID | O20101122001121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083946792 | NPI | - | NPPES |
| 01485712 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 196451 (New York) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Secondary |
| Provider Name | Imtiaz A Mallick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215943832 PECOS PAC ID: 2860535747 Enrollment ID: I20100201000111 |
| Provider Name | Timothy Childs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164731634 PECOS PAC ID: 5496923807 Enrollment ID: I20110729000019 |
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