Provider Demographics
NPI:1235201518
Name:DSA, LYGIA (MD)
Entity Type:Individual
Prefix:
First Name:LYGIA
Middle Name:
Last Name:DSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2627
Mailing Address - Country:US
Mailing Address - Phone:516-593-8648
Mailing Address - Fax:516-593-1391
Practice Address - Street 1:182 EARLE AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2627
Practice Address - Country:US
Practice Address - Phone:516-593-8648
Practice Address - Fax:516-593-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
74I631Medicare ID - Type Unspecified
F93537Medicare UPIN