Provider Demographics
NPI:1932869922
Name:ALLAN BUSH MEDICAL PRACTICE
Entity Type:Organization
Organization Name:ALLAN BUSH MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-673-8060
Mailing Address - Street 1:1044 FRANKLIN AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2938
Mailing Address - Country:US
Mailing Address - Phone:516-673-8060
Mailing Address - Fax:516-874-4371
Practice Address - Street 1:1044 FRANKLIN AVE STE 212
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2938
Practice Address - Country:US
Practice Address - Phone:516-673-8060
Practice Address - Fax:516-874-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty