Provider Demographics
NPI:1114920352
Name:LYNK, GARY E (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:LYNK
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 1:322 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1219
Mailing Address - Country:US
Mailing Address - Phone:518-828-3662
Mailing Address - Fax:518-828-3845
Practice Address - Street 1:322 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1219
Practice Address - Country:US
Practice Address - Phone:518-828-3662
Practice Address - Fax:518-828-3845
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-10-10
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
NYX007862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX007862OtherLICENSE NUMBER
NY40096OtherPRISM
NY906401OtherAETNA
NYX5Z91OtherEMPIRE BC/BS
10016419-L198OtherCDPHP
NY98L1039OtherMVP/LANDMARK
NY350051873OtherRAILROAD MEDICARE
NY5806496OtherGHI
NY906401OtherAETNA