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General NPI Number Information
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NPI Number | 1407872302
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Entity Type | Individual
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Provider Name | IVAN GREG HERSTIK DPM
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 95 UNIVERSITY PL 8TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-4515
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Country | US
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Telephone | 212-366-1718
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Fax | 212-366-4830
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Provider Business Mailing Address
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Address Line | 95 UNIVERSITY PL 8TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-4515
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Country | US
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Telephone | 212-366-1718
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Fax | 212-366-4830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004237
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2032
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License Number State | NJ
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