Provider Demographics
NPI:1922150846
Name:SEAN P. BOYLE
Entity Type:Organization
Organization Name:SEAN P. BOYLE
Other - Org Name:TRINITY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-834-6541
Mailing Address - Street 1:2523 STATE ROUTE 31
Mailing Address - Street 2:P O BOX 1095
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-3202
Mailing Address - Country:US
Mailing Address - Phone:315-834-6541
Mailing Address - Fax:315-834-6919
Practice Address - Street 1:2523 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-3202
Practice Address - Country:US
Practice Address - Phone:315-834-6541
Practice Address - Fax:315-834-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01523133Medicaid
NY01523133Medicaid
NYC24693Medicare UPIN