Provider Demographics
NPI:1346839024
Name:BUSH, ALDEN A (DNP, MPH, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ALDEN
Middle Name:A
Last Name:BUSH
Suffix:
Gender:M
Credentials:DNP, MPH, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STATE ST FL 40
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1547
Mailing Address - Country:US
Mailing Address - Phone:518-652-1352
Mailing Address - Fax:518-450-6484
Practice Address - Street 1:17 STATE ST FL 40
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1547
Practice Address - Country:US
Practice Address - Phone:518-652-1352
Practice Address - Fax:518-450-6484
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802060163W00000X
WARN61526851163W00000X
NY404163363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse