Provider Demographics
NPI:1881824548
Name:BOOTHE, DENIECE TAMARA (DO)
Entity Type:Individual
Prefix:DR
First Name:DENIECE
Middle Name:TAMARA
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 4F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3212
Mailing Address - Country:US
Mailing Address - Phone:718-530-3900
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09530500207RH0002X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine