Provider Demographics
NPI:1538285119
Name:FRANK, J. BUSH, M.D., PC
Entity Type:Organization
Organization Name:FRANK, J. BUSH, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-646-3903
Mailing Address - Street 1:27 HILLIARD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3001
Mailing Address - Country:US
Mailing Address - Phone:860-646-3903
Mailing Address - Fax:860-645-3492
Practice Address - Street 1:27 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3001
Practice Address - Country:US
Practice Address - Phone:860-646-3903
Practice Address - Fax:860-645-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty