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NPI Code Detail

MEDICARE: LYDIA BYUN ATR

MEDICARE: LYDIA BYUN ATR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor002043NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1JLJ721666467OTHERNYEMPIRE BLUE CROSS BLUE SHIELD NY ESSENTIAL PLAN

General Provider Information

NPI Number : 1316499767
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA BYUN ATR
Provider Business Mailing Address
First Line : 90 MESEROLE ST
Second Line : APT 1B
City : BROOKLYN
State : NY
Zip : 11206-2397
Country : US
Telephone Number : 973-600-9013
Fax Number :
Provider Business Practice Location Address
First Line : 3708 91ST ST
Second Line : SUITE 3A
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7961
Country : US
Telephone Number : 718-779-2263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2016
Last Update Date : 11/02/2016

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