Healthcare Provider Details

I. General information

NPI: 1548795958
Provider Name (Legal Business Name): ANDREW P BOOTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 655 A
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

3925 SHERIDAN DR STE 100
AMHERST NY
14226-1738
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2100
  • Fax:
Mailing address:
  • Phone: 716-250-6492
  • Fax: 716-250-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: