Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 309327-01 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 309327-01 | NY |
NPI | 1073169785 |
---|---|
Provider Name | Mr. Erik Craig Lyons |
First Address | Oceanside, NY 11572-3350 |
Second Address | Oceanside, NY 11572-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2019 |
Last Update Date | 18/08/2019 |