Provider Demographics
NPI:1295706497
Name:RUSH, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CHAPPAQUA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1354
Mailing Address - Country:US
Mailing Address - Phone:914-762-2276
Mailing Address - Fax:914-762-2894
Practice Address - Street 1:302 CHAPPAQUA RD STE 204
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1354
Practice Address - Country:US
Practice Address - Phone:914-762-2276
Practice Address - Fax:914-762-2894
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138713207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00759655Medicaid
NY96A471Medicare ID - Type Unspecified
NY00759655Medicaid