Provider Demographics
NPI:1457438681
Name:BOOTH, JAMES REED (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:REED
Last Name:BOOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:337 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4310
Mailing Address - Country:US
Mailing Address - Phone:845-634-9349
Mailing Address - Fax:845-639-3031
Practice Address - Street 1:337 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4310
Practice Address - Country:US
Practice Address - Phone:845-634-9349
Practice Address - Fax:845-639-3031
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1269152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00236686Medicaid
NY00236686Medicaid