Provider Demographics
NPI:1417010638
Name:BUSH, MICHAEL NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NEAL
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:360 E 72ND ST
Mailing Address - Street 2:APARTMENT B1210
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4753
Mailing Address - Country:US
Mailing Address - Phone:212-583-2990
Mailing Address - Fax:212-644-2522
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:SUITE 630
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-583-2990
Practice Address - Fax:212-644-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY139099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67A041Medicare ID - Type Unspecified
NYC11706Medicare UPIN