Healthcare Provider Details

I. General information

NPI: 1124326392
Provider Name (Legal Business Name): MAUREEN PATRICIA BYRNE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 STEWART AVE
GARDEN CITY NY
11530-4816
US

IV. Provider business mailing address

24 YORKSHIRE RD
ROCKVILLE CENTRE NY
11570-2211
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-8600
  • Fax:
Mailing address:
  • Phone: 516-705-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010184-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: