Provider Demographics
NPI:1336139682
Name:EASTON, LON BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:BENJAMIN
Last Name:EASTON
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 1:519A HERITAGE HLS
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1905
Mailing Address - Country:US
Mailing Address - Phone:914-262-6255
Mailing Address - Fax:
Practice Address - Street 1:519A HERITAGE HLS
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-1905
Practice Address - Country:US
Practice Address - Phone:914-262-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14318Medicare UPIN