Individual
DR. THOMAS R LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6740 4TH AVE FL 4, BROOKLYN, NY 11220-5350
(929) 455-2000
Mailing address
5800 3RD AVE, MANAGED CARE DEPARTMENT, BROOKLYN, NY 11220-3702
(718) 630-7477
(718) 630-7437
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
201563
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02095169
—
NY
01
—
0599173
GHI
NY
01
—
423G41
BLUE CROSS BLUE SHIELD
NY
01
—
P2114864
OXFORD
NY
Enumeration date
08/21/2006
Last updated
10/04/2021
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