Provider Demographics
NPI:1316054075
Name:LYON, CLAUDIA L (DO)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:L
Last Name:LYON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5616 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3419
Mailing Address - Country:US
Mailing Address - Phone:718-630-8695
Mailing Address - Fax:718-630-8697
Practice Address - Street 1:5616 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3419
Practice Address - Country:US
Practice Address - Phone:718-630-8695
Practice Address - Fax:718-630-8697
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY180938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01294586Medicaid
NY87F821Medicare ID - Type Unspecified
NYF30525Medicare UPIN