Provider Demographics
NPI:1518081710
Name:BARGAS, LYNNY ANTHONY RESQUITES (PT)
Entity Type:Individual
Prefix:MR
First Name:LYNNY ANTHONY
Middle Name:RESQUITES
Last Name:BARGAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 49TH ST
Mailing Address - Street 2:APT. B-16
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2453
Mailing Address - Country:US
Mailing Address - Phone:718-633-9016
Mailing Address - Fax:
Practice Address - Street 1:2048 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3521
Practice Address - Country:US
Practice Address - Phone:718-252-0300
Practice Address - Fax:718-252-3619
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type UnspecifiedPENDING