Individual
MICHAEL TYLER BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
784 FRANKLIN AVE STE 250, FRANKLIN LAKES, NJ 07417-1306
(844) 777-0910
(201) 560-0712
Mailing address
39 CEDAR GROVE PKWY, CEDAR GROVE, NJ 07009-1405
(973) 738-0627
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00452000
NJ
Other
Enumeration date
10/24/2017
Last updated
11/02/2018
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