Provider Demographics
NPI:1356493308
Name:RUSH, JEFFREY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:RUSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 LEGION ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4920
Mailing Address - Country:US
Mailing Address - Phone:516-221-4452
Mailing Address - Fax:
Practice Address - Street 1:2353 LEGION ST
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4920
Practice Address - Country:US
Practice Address - Phone:516-221-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0322341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00550918Medicaid