Provider Demographics
NPI:1619078367
Name:LYMAN, NEIL W (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:W
Last Name:LYMAN
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 1:83 HANOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1508
Mailing Address - Country:US
Mailing Address - Phone:973-736-2212
Mailing Address - Fax:973-736-2989
Practice Address - Street 1:83 HANOVER ROAD
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-736-2212
Practice Address - Fax:973-736-2989
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03597800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0528803Medicaid
NJ155779A4GMedicare ID - Type Unspecified
NJ0528803Medicaid