Provider Demographics
NPI:1265471684
Name:THOMAS LYO MEDICAL PC
Entity Type:Organization
Organization Name:THOMAS LYO MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:Z
Authorized Official - Last Name:LYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-358-7788
Mailing Address - Street 1:13987 35TH AVE APT L1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3551
Mailing Address - Country:US
Mailing Address - Phone:718-358-7788
Mailing Address - Fax:718-502-8436
Practice Address - Street 1:13987 35TH AVE APT L1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3551
Practice Address - Country:US
Practice Address - Phone:718-358-7788
Practice Address - Fax:718-502-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWET361Medicare PIN
DF2449Medicare PIN
NY06712Medicare PIN