Healthcare Provider Details

I. General information

NPI: 1568578342
Provider Name (Legal Business Name): JENNIFER BYRNE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SYLVAN AVE
MILLER PLACE NY
11764-2420
US

IV. Provider business mailing address

111 SYLVAN AVE
MILLER PLACE NY
11764-2420
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-4888
  • Fax: 631-928-4889
Mailing address:
  • Phone: 631-928-4888
  • Fax: 631-928-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: