Provider Demographics
NPI:1851399984
Name:BOOTH RADIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:BOOTH RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-4998
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-7344
Mailing Address - Country:US
Mailing Address - Phone:856-848-4998
Mailing Address - Fax:856-848-9288
Practice Address - Street 1:748 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3157
Practice Address - Country:US
Practice Address - Phone:856-848-4998
Practice Address - Fax:856-848-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ233132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2599503Medicaid
NJ039460Medicare ID - Type Unspecified