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NPI Code Detail

MEDICARE: BYRON ROY EASTERLY

MEDICARE: BYRON ROY EASTERLY
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
1314000000XSkilled Nursing Facility000163CT

General Provider Information

NPI Number : 1568614337
Entity Type Code : Individual
Provider Name (Legal Business Name) : BYRON ROY EASTERLY
Provider Business Mailing Address
First Line : PO BOX 118
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-0118
Country : US
Telephone Number : 860-227-6630
Fax Number :
Provider Business Practice Location Address
First Line : 245 LONG HILL RD
Second Line :
City : MIDDLETOWN
State : CT
Zip : 06457-4063
Country : US
Telephone Number : 860-227-6630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2008
Last Update Date : 10/10/2008

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Directions to “ BYRON ROY EASTERLY ” Practice Location

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