Provider Demographics
NPI:1982981056
Name:BARBARA JEAN WILK, M.D., P.C.
Entity Type:Organization
Organization Name:BARBARA JEAN WILK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIA PRESIDENT S CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-979-0091
Mailing Address - Street 1:181 SMITHTOWN BLVD
Mailing Address - Street 2:SUITE101
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1875
Mailing Address - Country:US
Mailing Address - Phone:631-979-0091
Mailing Address - Fax:631-979-0082
Practice Address - Street 1:181 SMITHTOWN BLVD
Practice Address - Street 2:SUITE101
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1875
Practice Address - Country:US
Practice Address - Phone:631-979-0091
Practice Address - Fax:631-979-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172814207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37K291OtherMEDICARE ID TYPE UNSPECIFIED
NY01346574Medicaid
NYF24543Medicare UPIN