Provider Demographics
NPI:1538320171
Name:GARGIULO, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FREDERICK DR
Mailing Address - Street 2:APT H6
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1732
Mailing Address - Country:US
Mailing Address - Phone:732-678-6228
Mailing Address - Fax:
Practice Address - Street 1:34 FREDERICK DR
Practice Address - Street 2:APT H6
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1732
Practice Address - Country:US
Practice Address - Phone:732-678-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TROO450900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist