Individual
RYAN H LILLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6 TECHNOLOGY DR, EAST SETAUKET, NY 11733-4079
(631) 689-6698
Mailing address
40 SYCAMORE CIR, STONY BROOK, NY 11790-3141
(631) 901-8986
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
020-873
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020-873
NEW YORK STATE EDUCATION DEPARTMENT
NY
Enumeration date
06/15/2017
Last updated
06/15/2017
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