Provider Demographics
NPI:1154820801
Name:BOYLAND, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:BOYLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2315
Mailing Address - Country:US
Mailing Address - Phone:908-566-6363
Mailing Address - Fax:
Practice Address - Street 1:1 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2315
Practice Address - Country:US
Practice Address - Phone:908-566-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer