Provider Demographics
NPI:1376772657
Name:BUSH, ANTOINETTE (DVM)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 IRVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6201
Mailing Address - Country:US
Mailing Address - Phone:201-759-0491
Mailing Address - Fax:201-833-3983
Practice Address - Street 1:14 IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6201
Practice Address - Country:US
Practice Address - Phone:201-759-0491
Practice Address - Fax:201-833-3983
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29VI00447100174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian