MEDICARE: JEFF BUSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	05027-1	NY

General Provider Information

NPI Number	:	1316996036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF BUSH

Provider Business Mailing Address
First Line	:	48 IVANHOE DR
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-1725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3917
Country	:	US
Telephone Number	:	718-891-0832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/08/2007

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Directions to “ JEFF BUSH ” Practice Location

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