Healthcare Provider Details

I. General information

NPI: 1639722457
Provider Name (Legal Business Name): CAITLIN BOYLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 07/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 59TH ST
NEW YORK NY
10022-1304
US

IV. Provider business mailing address

5370 65TH PL
MASPETH NY
11378-1654
US

V. Phone/Fax

Practice location:
  • Phone: 212-324-2229
  • Fax:
Mailing address:
  • Phone: 917-751-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344802
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number607040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: