Healthcare Provider Details

I. General information

NPI: 1417864166
Provider Name (Legal Business Name): KATHLEEN BOYETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POMPTON RD
WAYNE NJ
07470-2103
US

IV. Provider business mailing address

2064 ALLENWOOD RD
WALL TOWNSHIP NJ
07719-9681
US

V. Phone/Fax

Practice location:
  • Phone: 973-720-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number344737
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: