Basic Information
Provider Information
NPI: 1154502037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYRNE
FirstName: DAVID
MiddleName: J.
NamePrefix: MR.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 385 TREMONT AVE
Address2: PM & RS - OCCUPATIONAL THERAPY
City: EAST ORANGE
State: NJ
PostalCode: 070181023
CountryCode: US
TelephoneNumber: 9736761000
FaxNumber: 9733957160
Practice Location
Address1: 385 TREMONT AVE
Address2: PM & RS - OCCUPATIONAL THERAPY
City: EAST ORANGE
State: NJ
PostalCode: 070181023
CountryCode: US
TelephoneNumber: 9736761000
FaxNumber: 9733957160
Other Information
ProviderEnumerationDate: 11/19/2007
LastUpdateDate: 11/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X46TR000454200NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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