Healthcare Provider Details

I. General information

NPI: 1124937438
Provider Name (Legal Business Name): ROYALTY EXECUTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COOK AVE
YONKERS NY
10701-5213
US

IV. Provider business mailing address

105 COOK AVE
YONKERS NY
10701-5213
US

V. Phone/Fax

Practice location:
  • Phone: 914-506-0144
  • Fax:
Mailing address:
  • Phone: 914-506-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: LIZANN LYNCH
Title or Position: OWNER
Credential: CPC
Phone: 551-225-4533