Provider Demographics
NPI:1972590438
Name:LYONS, JOHN SHERRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SHERRY
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:SHERRY
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10335 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-240-9870
Mailing Address - Fax:262-240-9869
Practice Address - Street 1:308 WILLOW AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-418-1820
Practice Address - Fax:201-418-1822
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039726002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2109808Medicaid
NJ149400RAYMedicare PIN
NJ2109808Medicaid