Healthcare Provider Details

I. General information

NPI: 1982999033
Provider Name (Legal Business Name): ERIC J LYDON C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 OAK RIDGE LN
BRIDGEWATER MA
02324-2340
US

IV. Provider business mailing address

110 OAK RIDGE LN
BRIDGEWATER MA
02324-2340
US

V. Phone/Fax

Practice location:
  • Phone: 508-207-2100
  • Fax:
Mailing address:
  • Phone: 508-207-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: