Healthcare Provider Details

I. General information

NPI: 1730279563
Provider Name (Legal Business Name): LARNIE JAMAL BOOKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

IV. Provider business mailing address

33 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

V. Phone/Fax

Practice location:
  • Phone: 732-257-4330
  • Fax: 732-257-5986
Mailing address:
  • Phone: 732-257-4330
  • Fax: 732-257-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA06967700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: