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NPI Code Detail

MEDICARE: MIRANDA LYON

MEDICARE: MIRANDA LYON
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
1225100000XPhysical Therapist038158NY

General Provider Information

NPI Number : 1386043115
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA LYON
Provider Business Mailing Address
First Line : 333 EARLE OVINGTON BLVD
Second Line : SUITE 225
City : UNIONDALE
State : NY
Zip : 11553-3610
Country : US
Telephone Number : 516-321-2400
Fax Number :
Provider Business Practice Location Address
First Line : 54 MURRAY ST
Second Line :
City : NEW YORK
State : NY
Zip : 10007-2219
Country : US
Telephone Number : 212-453-4622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2014
Last Update Date : 08/18/2014

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Directions to “ MIRANDA LYON ” Practice Location

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