Provider Demographics
NPI:1053358689
Name:FALLICK, FREDERICK S (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:S
Last Name:FALLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:41 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1111
Mailing Address - Country:US
Mailing Address - Phone:914-693-6133
Mailing Address - Fax:
Practice Address - Street 1:SCARSDALE MEDICAL GROUP
Practice Address - Street 2:600 MAMARONECK AVENUE
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1928
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY180848207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744238Medicaid
NY01744238Medicaid