1811065501 NPI number — MR. JOHN J LYONS IV MASTER OF SCIENCE

Table of content: MR. JOHN J LYONS IV MASTER OF SCIENCE (NPI 1811065501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811065501 NPI number — MR. JOHN J LYONS IV MASTER OF SCIENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYONS
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
MASTER OF SCIENCE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811065501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 COLUMBIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-9446
Provider Business Mailing Address Fax Number:
518-828-9450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 COLUMBIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-9446
Provider Business Practice Location Address Fax Number:
518-828-9450
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Provider Taxonomy Codes

  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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