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General NPI Number Information
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NPI Number | 1851399984
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Entity Type | Organization
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Legal Business Name | BOOTH RADIOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 748 KINGS HWY
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City | WOODBURY
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State | NJ
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Zip | 08096-3157
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Country | US
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Telephone | 856-848-4998
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Fax | 856-848-9288
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | WOODBURY
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State | NJ
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Zip | 08096-7344
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Country | US
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Telephone | 856-848-4998
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Fax | 856-848-9288
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHAEL BROWN
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Credential |
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Telephone | 856-848-4998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 23313
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License Number State | NJ
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