Provider Demographics
NPI:1275595787
Name:LYO, THOMAS ZONG-XUN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ZONG-XUN
Last Name:LYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13987 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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20118647Medicaid
16H801Medicare PIN
NY20118647Medicaid
NYF70797Medicare UPIN