Provider Demographics
NPI:1467560532
Name:HERSTIK, BARRY G (DPM)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:G
Last Name:HERSTIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4109
Mailing Address - Country:US
Mailing Address - Phone:201-816-8778
Mailing Address - Fax:201-816-9009
Practice Address - Street 1:934 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5928
Practice Address - Country:US
Practice Address - Phone:718-389-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004973207X00000X, 213ES0131X
NJMD2186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01716361Medicaid
NJ7994702Medicaid
NJ029918Medicare PIN
NYP55761Medicare PIN
NJ741229NGRMedicare PIN
U32679Medicare UPIN