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NPI Code Detail

MEDICARE: MICHAEL BOOTH

MEDICARE: MICHAEL BOOTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1205635026
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BOOTH
Provider Business Mailing Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number : 312-503-1851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2025
Last Update Date : 05/26/2026

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Directions to “ MICHAEL BOOTH ” Practice Location

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