Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Ilisa Dawn Wallach, MD

Individual provider Internal Medicine Physician · NPI 1629139340

Dr. Ilisa Dawn Wallach, MD is an Internal Medicine in New York, New York. Graduated from New York Medical College in 1987, 39 years ago. Practices with Maimonides Faculty Practice Plan, a 246-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
39
Trained at
New York Medical College
Licensed in
NY
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1421 3rd Ave Fl 5
New York, NY 10028-1899
Phone: (212) 717-5700
Fax: (212) 717-5706
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 176452 (NY)
Cardiovascular Disease Physician Taxonomy 207RC0000X · Licence 176452 (NY)

Record details

NPI number1629139340
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedDecember 13, 2006
Last updated in NPPESFebruary 2, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Also practisesCARDIOVASCULAR DISEASE (CARDIOLOGY)
Medical schoolNEW YORK MEDICAL COLLEGE
Graduated 1987 (39 years in practice)
Group practice Maimonides Faculty Practice Plan — 246 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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