Healthcare Provider Details

I. General information

NPI: 1679040794
Provider Name (Legal Business Name): BRIAN LYONS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4898
US

IV. Provider business mailing address

PO BOX 112019
NAPLES FL
34108-0134
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1000
  • Fax:
Mailing address:
  • Phone: 239-624-0400
  • Fax: 239-624-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA9117633
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: