MTB First Assist LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

MTB FIRST ASSIST LLC

Practice address

136 Ball Rd
Mountain Lakes, NJ 07046-1625

Phone

(973) 738-0627

NPI assigned

Nov 21, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Tyler Booth, PANPI 1811408313

Title

Owner

Phone

(973) 738-0627

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Tyler Booth, PA

  • Physician Assistant
  • Franklin Lakes, NJ
  • NPI 1811408313

  NJ

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1497520159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 BALL RD",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 BALL RD",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461625",
            "telephone_number": "973-738-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTB FIRST ASSIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-21",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-738-0627",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Lakes Medical Center, LLC
• Mountain Lakes Pathology LLC
• Mountain Lakes Premier Dental , LLC
• Mountain Lakes Psychotherapy, LLC
• Mpower Physical Therapy LLC
• Sheikh Marie Naeem, MD
• Elizabeth Niewood
• Anjalee Sriram Nirgudkar, PH. D., BCBA-D
• Heidi O'Donnell, MSW LCSW
• Theresa Catherine O'Neill, L.A.C.

• All providers in Mountain Lakes, NJ
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.