Provider Demographics
NPI:1124352414
Name:BERGADO, EMIL BIMBO ARGUIL (PT)
Entity type:Individual
Prefix:
First Name:EMIL BIMBO
Middle Name:ARGUIL
Last Name:BERGADO
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 1:3211 55TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1906
Mailing Address - Country:US
Mailing Address - Phone:631-839-5550
Mailing Address - Fax:
Practice Address - Street 1:3211 55TH ST
Practice Address - Street 2:APT. 1
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1906
Practice Address - Country:US
Practice Address - Phone:631-839-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist