Provider Demographics
NPI:1508874579
Name:BARK, GREGORY VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:BARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 MERRICK ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MASSAPEUEA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-799-6767
Mailing Address - Fax:516-799-6904
Practice Address - Street 1:4160 MERRICK ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:MASSAPEUEA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-799-6767
Practice Address - Fax:516-799-6904
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3310-2OtherWORKERS COMP
NYX20131Medicare ID - Type Unspecified