Provider Demographics
NPI:1770631251
Name:BYRAM MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:BYRAM MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-691-7551
Mailing Address - Street 1:13C ROUTE 206
Mailing Address - Street 2:BYRAM MEDICAL ASSOCIATES PC
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874
Mailing Address - Country:US
Mailing Address - Phone:973-691-7551
Mailing Address - Fax:973-691-7621
Practice Address - Street 1:13C ROUTE 206
Practice Address - Street 2:BYRAM MEDICAL ASSOCIATES PC
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874
Practice Address - Country:US
Practice Address - Phone:973-691-7551
Practice Address - Fax:973-691-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98515Medicare UPIN
615458Medicare PIN