Provider Demographics
NPI:1619156825
Name:DOUGLAS A. BYRNES, MD, PC
Entity Type:Organization
Organization Name:DOUGLAS A. BYRNES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-425-1616
Mailing Address - Street 1:152 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2958
Mailing Address - Country:US
Mailing Address - Phone:631-425-1616
Mailing Address - Fax:631-425-1630
Practice Address - Street 1:152 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2958
Practice Address - Country:US
Practice Address - Phone:631-425-1616
Practice Address - Fax:631-425-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WZVXZ1Medicare PIN