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General NPI Number Information
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NPI Number | 1407794282
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE MEDICAL
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 5640 SUNRISE HWY
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City | SAYVILLE
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State | NY
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Zip | 11782-1016
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Country | US
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Telephone | 516-761-1668
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Fax |
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Provider Business Mailing Address
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Address Line | 5640 SUNRISE HWY
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City | SAYVILLE
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State | NY
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Zip | 11782-1016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER/PHYSICIAN
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Name | ANTHONY J LYON
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Credential | MD
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Telephone | 516-761-1668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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