1114920352 NPI number — DR. GARY E LYNK DC

Table of content: DR. GARY E LYNK DC (NPI 1114920352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114920352 NPI number — DR. GARY E LYNK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNK
Provider First Name:
GARY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114920352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/20/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 FAIRVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-3662
Provider Business Mailing Address Fax Number:
518-828-3845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-3662
Provider Business Practice Location Address Fax Number:
518-828-3845
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X007862 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: X007862 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 40096 . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 906401 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X5Z91 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10016419-L198 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98L1039 . This is a "MVP/LANDMARK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 350051873 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5806496 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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