MEDICARE: DR. THOMAS R LYON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	201563	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2114864	OTHER	NY	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0599173	OTHER	NY	GHI
4	423G41	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1891800371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS R LYON M.D.

Provider Business Mailing Address
First Line	:	5800 3RD AVE
Second Line	:	MANAGED CARE DEPARTMENT
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3702
Country	:	US
Telephone Number	:	718-630-7477
Fax Number	:	718-630-7437

Provider Business Practice Location Address
First Line	:	6740 4TH AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5350
Country	:	US
Telephone Number	:	929-455-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	10/04/2021

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