Lyceum Physical Medicine, PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LYCEUM PHYSICAL MEDICINE, PC

Practice address

6062 Ridge Avenue
Philadelphia, PA 19128

Phone

(215) 508-5555

NPI assigned

May 17, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William J Pezzello, DC

Title

Owner

Phone

(215) 508-5555

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1235422759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6062 RIDGE AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19128",
            "telephone_number": "215-508-5555",
            "fax_number": "215-508-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6062 RIDGE AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19128",
            "telephone_number": "215-508-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCEUM PHYSICAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "PEZZELLO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-508-5555",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "PA",
            "license": "MD034915E",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "MD032971E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1137870",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Ly
• Katty Lyamzin, DPT
• Janice Ann Lybrand, M.D.
• Lyceum Chiropractic, P.C.
• Lyceum Longevity Center PLLC
• Jennifer Lydic
• Bridget Katherine Lydon, CRNP
• Michael J Lydon
• Nicole Lynn Lydon, CRNP
• Charles Jonathan Lyerly, DPM

• Physical Medicine & Rehabilitation Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physical Medicine & Rehabilitation Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.