Provider Demographics
NPI:1871511162
Name:LYONS, ANDREW WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
Last Name:LYONS
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: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:877-636-0628
Practice Address - Street 1:125 PARK DR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10464-1005
Practice Address - Country:US
Practice Address - Phone:917-576-6895
Practice Address - Fax:877-363-0628
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01961242Medicaid
NYG400014337Medicare PIN
NYG91310Medicare UPIN
NY49C07WYYS1Medicare PIN
NY01961242Medicaid