Healthcare Provider Details

I. General information

NPI: 1063594869
Provider Name (Legal Business Name): JOSEPH L. BYRNE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 MEDICAL CENTER DR
FAYETTEVILLE NY
13066-6642
US

IV. Provider business mailing address

4206 MEDICAL CENTER DR
FAYETTEVILLE NY
13066-6642
US

V. Phone/Fax

Practice location:
  • Phone: 315-329-7770
  • Fax: 315-329-7772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number129580
License Number StateNY

VIII. Authorized Official

Name: JOSEPH L BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 315-329-7770