Healthcare Provider Details

I. General information

NPI: 1588851182
Provider Name (Legal Business Name): LINDA C BOOTH DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WASHINGTON STREET SUITE 401
HOBOKEN NJ
07030
US

IV. Provider business mailing address

27 VAN BUREN AVENUE
CARTERET NJ
07008
US

V. Phone/Fax

Practice location:
  • Phone: 201-653-7450
  • Fax:
Mailing address:
  • Phone: 201-653-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA C BOOTH
Title or Position: CEO
Credential: DO
Phone: 201-653-7450