Healthcare Provider Details

I. General information

NPI: 1003732199
Provider Name (Legal Business Name): TYRONE G LIGON JR. LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 BLUE POINT AVE
BLUE POINT NY
11715-1224
US

IV. Provider business mailing address

22 SUMMERSWEET DR
MIDDLE ISLAND NY
11953-2716
US

V. Phone/Fax

Practice location:
  • Phone: 631-419-6737
  • Fax: 631-868-3498
Mailing address:
  • Phone: 631-506-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number338146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: