Provider Demographics
NPI:1932198165
Name:RUSH, STEVEN JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAY
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 1:168 W 86TH ST
Mailing Address - Street 2:#10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4022
Mailing Address - Country:US
Mailing Address - Phone:212-580-0304
Mailing Address - Fax:
Practice Address - Street 1:525 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4063
Practice Address - Country:US
Practice Address - Phone:718-714-0105
Practice Address - Fax:718-714-0108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00181219Medicaid
NY311112Medicare ID - Type Unspecified
C08225Medicare UPIN