Provider Demographics
NPI:1689601767
Name:O'CONNOR, LYNN M (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:51 RUSHMORE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4427
Mailing Address - Country:US
Mailing Address - Phone:631-350-6277
Mailing Address - Fax:631-350-2966
Practice Address - Street 1:380 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2869
Practice Address - Country:US
Practice Address - Phone:631-350-6277
Practice Address - Fax:631-350-2966
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056159208C00000X
NY240343208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
28BBBCZMedicare ID - Type Unspecified
I30425Medicare UPIN