Provider Demographics
NPI:1295502235
Name:ALDEN BUSH DNP - NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ALDEN BUSH DNP - NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MPH
Authorized Official - Phone:518-652-1352
Mailing Address - Street 1:17 STATE ST FL 40
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1547
Mailing Address - Country:US
Mailing Address - Phone:518-652-1352
Mailing Address - Fax:518-450-6484
Practice Address - Street 1:17 STATE ST FL 40
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1547
Practice Address - Country:US
Practice Address - Phone:518-652-1352
Practice Address - Fax:518-450-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health