Provider Demographics
NPI:1194809772
Name:BYRNE, KRISTIN C (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:C
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0985
Mailing Address - Country:US
Mailing Address - Phone:518-793-1000
Mailing Address - Fax:518-761-4674
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-793-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2367812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672008Medicaid
NY770T61OtherEMPIRE BCBS
NJ0075922Medicaid
NYI40143Medicare UPIN
NY02672008Medicaid
NYP00351077Medicare PIN
NJ0075922Medicaid
NYKB0770T610Medicare PIN