Provider Demographics
NPI:1811087190
Name:WILK, BARBARA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA JEAN
Middle Name:
Last Name:WILK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SMITHTOWN BLVD
Mailing Address - Street 2:SUITE 101
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:
Practice Address - Street 1:181 SMITHTOWN BLVD
Practice Address - Street 2:SUITE 101
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172814-1207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01346574Medicaid
NY37K291Medicare ID - Type Unspecified
NY01346574Medicaid