Provider Demographics
NPI:1578109245
Name:ALLAN BUSH
Entity Type:Organization
Organization Name:ALLAN BUSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLEY-BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-641-4300
Mailing Address - Street 1:60 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4159
Mailing Address - Country:US
Mailing Address - Phone:516-850-6040
Mailing Address - Fax:516-871-4371
Practice Address - Street 1:60 N PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4159
Practice Address - Country:US
Practice Address - Phone:516-850-6040
Practice Address - Fax:516-871-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty