Provider Demographics
NPI:1427439132
Name:LYNCH, SEAN (DPM)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1599
Mailing Address - Country:US
Mailing Address - Phone:631-928-8383
Mailing Address - Fax:631-928-8388
Practice Address - Street 1:1 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1599
Practice Address - Country:US
Practice Address - Phone:631-928-8383
Practice Address - Fax:631-928-8388
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006952213ES0131X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program