Provider Demographics
NPI:1538121942
Name:BYRNE, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BYRNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-632-9422
Mailing Address - Fax:914-632-3225
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE LL2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-632-9422
Practice Address - Fax:914-632-3225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00510009Medicaid
NYC11412Medicare UPIN
NY563102Medicare ID - Type Unspecified