Provider Demographics
NPI:1487664074
Name:BARK, NIGEL MARTYN (MD)
Entity Type:Individual
Prefix:DR
First Name:NIGEL
Middle Name:MARTYN
Last Name:BARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2733
Mailing Address - Country:US
Mailing Address - Phone:845-359-7553
Mailing Address - Fax:845-359-7553
Practice Address - Street 1:117 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2733
Practice Address - Country:US
Practice Address - Phone:845-359-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1295942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY323632Medicare ID - Type UnspecifiedROCKLAND COUNTY
CO8470Medicare UPIN
NY323631Medicare ID - Type UnspecifiedNYC