MEDICARE: MRS. MARY K. BOYLAN SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1215180419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY K. BOYLAN SLP

Provider Business Mailing Address
First Line	:	2320 BRONX PARK E
Second Line	:	5J
City	:	BRONX
State	:	NY
Zip	:	10467-7546
Country	:	US
Telephone Number	:	718-798-6040
Fax Number	:	718-798-6040

Provider Business Practice Location Address
First Line	:	2320 BRONX PARK E
Second Line	:	5J
City	:	BRONX
State	:	NY
Zip	:	10467-7546
Country	:	US
Telephone Number	:	718-798-6040
Fax Number	:	718-798-6040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	10/31/2008

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