Provider Demographics
NPI:1780602052
Name:LYON, LEONARD J (PA)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:LYON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 SADDLE RANCH LN
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1318
Mailing Address - Country:US
Mailing Address - Phone:201-391-1078
Mailing Address - Fax:201-391-5388
Practice Address - Street 1:400 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2732
Practice Address - Country:US
Practice Address - Phone:201-391-1078
Practice Address - Fax:201-391-5388
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA21990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLYO73959Medicare ID - Type Unspecified
NJD07003Medicare UPIN