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Organization
IMTIAZ A. MALLICK PHYSICIAN P.C
Active
Organization
IMTIAZ A. MALLICK PHYSICIAN P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMTIAZ A MALLICK M.D. (PRESIDENT & CEO)
(845) 896-2204
Entity
Organization
Contact information
Practice address
798 ROUTE 9, FISHKILL, NY 12524-1393
(845) 896-2204
(845) 896-5173
Mailing address
798 ROUTE 9, FISHKILL, NY 12524-1393
(845) 896-2204
(845) 896-5173
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196451
NY
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01485712
—
NY
Enumeration date
02/04/2010
Last updated
03/05/2022
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