Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 249377 | NY |
N | 2081P2900X | Pain Medicine | 249377 | NY |
NPI | 1255344644 |
---|---|
Provider Name | Dr. Thomas John Booker |
First Address | Middletown, NY 10941-4028 |
Second Address | Middletown, NY 10941-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 16/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03021749 | (05) | NY |