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General NPI Number Information
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NPI Number | 1356797138
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Entity Type | Individual
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Provider Name | MATTHEW RYAN BOYLAN MD MPH
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Gender | Male
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD STE 204
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1977
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Country | US
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Telephone | 631-302-7349
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 STEWART AVE STE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-4833
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Country | US
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Telephone | 516-838-8739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 317403
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License Number State | NY
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