Provider Demographics
NPI:1174684955
Name:BOYLAN, PATRICIA COLLEEN (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:COLLEEN
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1444
Mailing Address - Country:US
Mailing Address - Phone:732-842-1646
Mailing Address - Fax:
Practice Address - Street 1:530 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1444
Practice Address - Country:US
Practice Address - Phone:732-842-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00158900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1702700Medicaid
NJB0453740Medicare ID - Type Unspecified
T45352Medicare UPIN