Ilisa Dawn Wallach, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

176452 Issued in NY

Practice address

1421 3Rd Ave FL 5
New York, NY 10028-1899

Phone

(212) 717-5700

Fax

(212) 717-5706

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Ilisa Dawn Wallach Professional name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Cardiovascular Disease (Cardiology)

Education

New York Medical College, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maimonides Faculty Practice PlanGroup PAC ID 7012808348, 251 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Maimonides Medical Center Hospital, Brooklyn, NY, CCN 330194

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: ilisawallach@mai.allscriptsdirect.net
• Direct secure messaging: ilisa.wallach.p1@direct.mmc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment Care Compare group NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• Lenox Hill Cardiology Associates

  • Specialist
  • New York, NY
  • NPI 1487780870
  NPD (past)
• New York Integrative Rheumatology&Arthritis Care, PC

  • Rheumatology Physician
  • New York, NY
  • NPI 1851522122
  NPD (past)
• Park Avenue Medical & Surgical Associates

  • Surgery Physician
  • New York, NY
  • NPI 1619082765
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  Care Compare affiliation

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1629139340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 3RD AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100281899",
            "telephone_number": "212-717-5700",
            "fax_number": "212-717-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 3RD AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100281899",
            "telephone_number": "212-717-5700",
            "fax_number": "212-717-5706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "ILISA",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "176452",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "176452",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ILISA",
            "last_name": "WALLACH",
            "middle_name": "DAWN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Racquel Elizabeth Wallace, MFT
• Sybille Wallace, M.D.
• Andrew Brian Wallach, MD
• Elizabeth Wallach, M.D.
• Frances R Wallach, MD
• Jacob Wallach
• Jeffrey D Wallach, M.D.
• Jennifer Wallach, PHD
• Judith D Wallach, PHD
• Mary Wallach, MSW, LCSW

• Internal Medicine Physician in New York, NY
• Providers in New York, 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 Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.