Provider Demographics
NPI:1407872302
Name:HERSTIK, IVAN GREG (DPM)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:GREG
Last Name:HERSTIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 UNIVERSITY PL
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4515
Mailing Address - Country:US
Mailing Address - Phone:212-366-1718
Mailing Address - Fax:212-366-4830
Practice Address - Street 1:95 UNIVERSITY PL
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4515
Practice Address - Country:US
Practice Address - Phone:212-366-1718
Practice Address - Fax:212-366-4830
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN004237213E00000X
NJ2032213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C2183OtherPHS HEALTHNET
NYNS816OtherOXFORD HEALTH PLAN
NY01716334Medicaid
NYP50031OtherBCBS
NYP50031OtherBCBS