Provider Demographics
NPI:1669554440
Name:BYRNE, JOSEPH L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:BYRNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4206 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-329-7770
Mailing Address - Fax:315-329-7772
Practice Address - Street 1:4206 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-329-2600
Practice Address - Fax:315-744-1936
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-01-09
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Provider Licenses
StateLicense IDTaxonomies
NY1295802083P0011X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00591199Medicaid
NY00591199Medicaid
NYC59081Medicare UPIN
NY020000179Medicare PIN