MEDICARE: DR. BRETA DORA BOOTS DO

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
1	207R00000X	Internal Medicine Physician	OT013986	PA
2	2084N0400X	Neurology Physician	262355	MA
3	2084N0400X	Neurology Physician	333151	NY

General Provider Information

NPI Number	:	1891080255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETA DORA BOOTS DO

Provider Business Mailing Address
First Line	:	1111 WESTCHESTER AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3525
Country	:	US
Telephone Number	:	646-426-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 WESTCHESTER AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3525
Country	:	US
Telephone Number	:	646-426-3876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	08/22/2025

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