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General NPI Number Information
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NPI Number | 1942412069
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Entity Type | Individual
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Provider Name | ROBERT LEE BOOTHE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 457 MARTLING AVE
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City | TARRYTOWN
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State | NY
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Zip | 10591
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Country | US
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Telephone | 914-332-9552
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Fax |
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Provider Business Mailing Address
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Address Line | 806 BRENTWOOD DR
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City | TARRYTOWN
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State | NY
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Zip | 10591-5054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 60-094646
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License Number State | NY
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