Healthcare Provider Details

I. General information

NPI: 1265471684
Provider Name (Legal Business Name): THOMAS LYO MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13987 35TH AVE APT L1
FLUSHING NY
11354-3551
US

IV. Provider business mailing address

13987 35TH AVE APT L1
FLUSHING NY
11354-3551
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-7788
  • Fax: 718-502-8436
Mailing address:
  • Phone: 718-358-7788
  • Fax: 718-502-8436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS Z LYO
Title or Position: PRESIDENT
Credential: MD
Phone: 718-358-7788