Provider Demographics
NPI:1679721112
Name:LYON, DEREK GEORGE (NP)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:GEORGE
Last Name:LYON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W 14TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7406
Mailing Address - Country:US
Mailing Address - Phone:646-928-0277
Mailing Address - Fax:646-928-0269
Practice Address - Street 1:39 W 14TH ST STE 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7406
Practice Address - Country:US
Practice Address - Phone:646-928-0277
Practice Address - Fax:646-928-0269
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430382363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care