MEDICARE: DAVID JOSEPH BYRNES ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	001102-1	NY

General Provider Information

NPI Number	:	1467426197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOSEPH BYRNES ATC

Provider Business Mailing Address
First Line	:	27 BUSH CREEK LN
Second Line	:
City	:	POUGHQUAG
State	:	NY
Zip	:	12570-5557
Country	:	US
Telephone Number	:	914-760-1428
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 CROMPOND RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3129
Country	:	US
Telephone Number	:	914-760-1428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	12/03/2008

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