Provider Demographics
NPI:1255671012
Name:VARGAS, DAVID (LMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 STAGG ST
Mailing Address - Street 2:APT. 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1463
Mailing Address - Country:US
Mailing Address - Phone:718-644-6836
Mailing Address - Fax:
Practice Address - Street 1:196 STAGG ST
Practice Address - Street 2:APT. 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1463
Practice Address - Country:US
Practice Address - Phone:718-644-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-024975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist