Kaitlyn E Booth, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP00245300 Issued in NJ

Practice address

560 1St Ave
New York, NY 10016-6402

Phone

(212) 263-0250

NPI assigned

Dec 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• L&M Physician Association, Inc

  • Family Medicine Physician
  • Ledyard, CT
  • NPI 1386972693
  NPD (past)

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

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1700180106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GALWAY PL",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663640",
            "telephone_number": "201-833-9500",
            "fax_number": "201-862-0095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-0250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "663 Palisade Ave",
            "address_2": "STE 302",
            "address_purpose": "LOCATION",
            "city": "Cliffside Park",
            "state": "NJ",
            "postal_code": "070103012",
            "country_code": "US",
            "telephone_number": "201-943-9100",
            "fax_number": "201-943-7308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "KAITLYN",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-29",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00245300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbooth126795@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "560 1st Ave",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100166402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert Jay Boorstein, MD
• Kourtnee Elaine Boose
• Michelle Booso, MA CCC SLP
• Alan Booth, LMSW
• Diane G Booth, LCSW
• Katherine Stevens Booth
• Khristina Booth, DO
• Margaret Anne Booth, OTD, OTR/L
• Michael Booth, PA-C
• Nadine Booysen

• Surgical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.