Provider Demographics
NPI:1356557730
Name:LYON & MARTIN MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LYON & MARTIN MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-750-8330
Mailing Address - Street 1:59 E 54TH ST
Mailing Address - Street 2:23
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4211
Mailing Address - Country:US
Mailing Address - Phone:212-750-8764
Mailing Address - Fax:
Practice Address - Street 1:59 E 54TH ST
Practice Address - Street 2:23
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4211
Practice Address - Country:US
Practice Address - Phone:212-750-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE99503Medicare UPIN
NY20I293Medicare PIN
NYF21025Medicare UPIN
NY83F113Medicare PIN
NYW86671Medicare PIN