Lyceum Longevity Center PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LYCEUM LONGEVITY CENTER PLLC

Practice address

6062 Ridge Ave
Philadelphia, PA 19128-1647

Phone

(215) 508-5555

Fax

(215) 508-5555

NPI assigned

Oct 31, 2018

Last updated

Oct 4, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William J PezzelloNPI 1720278740

Title

Co-Founder

Phone

(215) 508-5555

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William J Pezzello Jr., D.C.

  • Chiropractor
  • Philadelphia, PA
  • NPI 1720278740
  Medicare reassignment NPD Authorized official
• Matthew P Cahill, MD

  • Internal Medicine Physician
  • Bryn Mawr, PA
  • NPI 1528031325
  Medicare reassignment NPD
• Paul L Ezeukwu, MSPT

  • Specialist
  • Philadelphia, PA
  • NPI 1326175936
  Medicare reassignment NPD
• Geenander Kaur Raju, DNP, CRNP, FNP-BC

  • Family Nurse Practitioner
  • Kane, PA
  • NPI 1356823959
  Medicare reassignment NPD
• Patricia Eileen Woods, M.D.

  • Hospitalist Physician
  • Pittsburgh, PA
  • NPI 1760614655
  Medicare reassignment NPD
• Panya Asabi Henry

  • Psychiatric/Mental Health Nurse Practitioner
  • Nashville, NC
  • NPI 1124681507

  PA

  Medicare reassignment NPD
• Samuel Schepart

  • Chiropractor
  • Lutz, FL
  • NPI 1528536901

  PA

  Medicare reassignment NPD
• Michele Rocco Boyle, PA C

  • Medical Physician Assistant
  • Philadelphia, PA
  • NPI 1275571424
  Medicare reassignment
• Aashka Shah, PA

  • Physician Assistant
  • Wilmington, DE
  • NPI 1972261220

  PA

  Medicare reassignment

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

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1831666585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6062 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191281647",
            "telephone_number": "215-508-5555",
            "fax_number": "215-508-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6062 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191281647",
            "telephone_number": "215-508-5555",
            "fax_number": "215-508-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCEUM LONGEVITY CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-31",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "PEZZELLO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "215-508-5555"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecka Ly
• Steven Ly
• Katty Lyamzin, DPT
• Janice Ann Lybrand, M.D.
• Lyceum Chiropractic, P.C.
• Lyceum Physical Medicine, PC
• Jennifer Lydic
• Bridget Katherine Lydon, CRNP
• Michael J Lydon
• Nicole Lynn Lydon, CRNP

• Specialist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.