=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831464098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEIN SPECIALIST OF NEW YORK, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2012
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 E 37TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-365-8788
-----------------------------------------------------
Fax | 646-351-0899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 E 37TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-365-8788
-----------------------------------------------------
Fax | 646-351-0899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. ROSS T. LYON
-----------------------------------------------------
Credential | MD, FACS
-----------------------------------------------------
Telephone | 212-365-8788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 183465
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 183465
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------