Imtiaz a. Mallick Physician P.C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

196451 Issued in NY

Legal business name

IMTIAZ A. MALLICK PHYSICIAN P.C

Practice address

798 Route 9
Fishkill, NY 12524-1393

Phone

(845) 896-2204

Fax

(845) 896-5173

NPI assigned

Feb 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Imtiaz A Mallick, M.D.NPI 1215943832

Title

President & Ceo

Phone

(845) 896-2204

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Imtiaz A Mallick, MD

  • Internal Medicine Physician
  • Fishkill, NY
  • NPI 1215943832
  Medicare reassignment NPD Authorized official
• Timothy A Childs, FNP

  • Family Nurse Practitioner
  • Bronx, NY
  • NPI 1164731634
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646438400000",
    "number": "1083946792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "798 ROUTE 9",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125241393",
            "telephone_number": "845-896-2204",
            "fax_number": "845-896-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "798 ROUTE 9",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125241393",
            "telephone_number": "845-896-2204",
            "fax_number": "845-896-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMTIAZ A. MALLICK PHYSICIAN P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-04",
        "last_updated": "2022-03-05",
        "certification_date": "2022-03-05",
        "status": "A",
        "authorized_official_last_name": "MALLICK",
        "authorized_official_first_name": "IMTIAZ",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "845-896-2204",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196451",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01485712",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@imallickmd.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "798 Route 9",
            "city": "Fishkill",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125241393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erin E Hunt, MSPAS, PA-C
• Christina Iamarino
• Ident Dental at Fishkill
• Armon Imbriglio, PA
• Immediate Medical Health Care
• Incledon Chiropractic LLC
• Incledon Chiropractic Office, PLLC
• John D Incledon III, DC
• Leandra Carmen Infante, LMSW
• Integrated Health Solutions, Inc.

• Internal Medicine Physician in Fishkill, NY
• Providers in Fishkill, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.