Provider Demographics
NPI:1629297528
Name:BOYLE, NOREEN M (PT, DPT, MA)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PT, DPT, MA
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:166 RIDGEDALE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4085
Practice Address - Country:US
Practice Address - Phone:973-455-0254
Practice Address - Fax:732-855-9755
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01143600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087731Medicare PIN