33D0921389 CLIA NUMBER - IMTIAZ A MALLICK MD PC

Laboratory Demographics

  • CLIA Code: 33D0921389
  • Facility Name: IMTIAZ A MALLICK MD PC
  • Facility Address: 798 ROUTE 9, SUITE H
    FISHKILL, NY
    ZIP 12524
  • Facility Phone: 845 896-2204
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. IMTIAZ A. MALLICK
  • NPI Number: 1215943832
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 33D0921389
LAB Type Physician Office
Facility Name IMTIAZ A MALLICK MD PC
Street 798 ROUTE 9, SUITE H
City FISHKILL
State NY
ZIP 12524
Phone 845 896-2204
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Physician Office
Lab Director DR. IMTIAZ A. MALLICK

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This page was last updated on: 3/20/2025