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Contact Information

RYAN H LILLEY, PA-C
6 TECHNOLOGY DR
EAST SETAUKET, NY11733-4079
 Phone: 631-689-6698
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

207XX0005X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for RYAN H LILLEY · (Male)

NPI Number 1962932467
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 06/15/2017
Last updated 06/15/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 020-873
  • NY Other 020-873 NEW YORK STATE EDUCATION DEPARTMENT
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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