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Individual
DR. ILISA DAWN WALLACH
Active
Individual
DR. ILISA DAWN WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
176452
NY
207RC0000X
Cardiovascular Disease Physician
176452
NY
Other
Enumeration date
12/13/2006
Last updated
02/02/2016
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