Provider Demographics
NPI:1184706715
Name:BOYLE, DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 JERICHO TPKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2812
Mailing Address - Country:US
Mailing Address - Phone:631-462-5222
Mailing Address - Fax:631-462-5258
Practice Address - Street 1:5036 JERICHO TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2812
Practice Address - Country:US
Practice Address - Phone:631-462-5222
Practice Address - Fax:631-462-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV67013Medicare UPIN