Provider Demographics
NPI:1710020094
Name:ANDREW W LYONS, MD
Entity Type:Organization
Organization Name:ANDREW W LYONS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-576-6895
Mailing Address - Street 1:PO BOX 8503
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-8503
Mailing Address - Country:US
Mailing Address - Phone:917-576-6895
Mailing Address - Fax:
Practice Address - Street 1:222 E 93RD ST
Practice Address - Street 2:SUITE 24D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3744
Practice Address - Country:US
Practice Address - Phone:212-861-3313
Practice Address - Fax:212-987-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01961242Medicaid
NY49C072Medicare ID - Type Unspecified
NY01961242Medicaid