Healthcare Provider Details

I. General information

NPI: 1750344388
Provider Name (Legal Business Name): THOMAS JOHN BYRNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 MALCOLM X BLVD
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 LENOX AVE 4335
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-1700
  • Fax: 505-546-3958
Mailing address:
  • Phone: 212-939-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number162064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: