Basic Information
| Provider Information | |||||||||
| NPI: | 1467656496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRNE | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 CRYSTAL RUN RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109414057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457036999 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 BLOOMING GROVE TPKE | ||||||||
| Address2: | |||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455618060 | ||||||||
| FaxNumber: | 8455618523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 026213-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Q398G2 | 01 | NY | EMPIRE BCBS OF NY PALTZ | OTHER | 141796305 | 01 | NY | TAX ID # | OTHER | 110559500 | 01 | NY | US DEPARTMENT OF LABOR | OTHER | Q398G1 | 01 | NY | EMPIRE BCBS OF NY WINDSOR | OTHER | 141796305 | 01 | NY | TAX ID# | OTHER | 6009818 | 01 | NY | MVP | OTHER |