1710020094 NPI number — ANDREW W LYONS, MD

Table of content: (NPI 1710020094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710020094 NPI number — ANDREW W LYONS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW W LYONS, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710020094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10803-8503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-576-6895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E 93RD ST
Provider Second Line Business Practice Location Address:
SUITE 24D
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-861-3313
Provider Business Practice Location Address Fax Number:
212-987-2394
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
917-576-6895

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  209536 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01961242 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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