Provider Demographics
NPI:1891319570
Name:BYRNE, NATHAN PHILIP (PA-C, MLS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PHILIP
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PA-C, MLS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-7576
Mailing Address - Fax:
Practice Address - Street 1:460 BLISS RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1548
Practice Address - Country:US
Practice Address - Phone:413-657-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical