Basic Information
| Provider Information | |||||||||
| NPI: | 1003148776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 ROBERT PITT DR | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457701949 | ||||||||
| FaxNumber: | 8455032214 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 CALVERT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105283131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452167775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F332068-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | F404084 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.