Provider Demographics
NPI:1750951992
Name:LYONS, WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:BILLY
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:16 DANA LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2313
Mailing Address - Country:US
Mailing Address - Phone:631-747-5576
Mailing Address - Fax:
Practice Address - Street 1:45 RESEARCH WAY STE 108
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6401
Practice Address - Country:US
Practice Address - Phone:631-941-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant