Healthcare Provider Details

I. General information

NPI: 1487841755
Provider Name (Legal Business Name): LIZIA K KYE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUNRISE HWY STE 3B
GREAT RIVER NY
11739-1001
US

IV. Provider business mailing address

9 NEWBROOK LN
EAST NORTHPORT NY
11731-5230
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: