Healthcare Provider Details

I. General information

NPI: 1114959541
Provider Name (Legal Business Name): MATTHEW BUSHEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST SOUTH UNION SQUARE
SOUTHBURY CT
06488
US

IV. Provider business mailing address

385 MAIN ST SOUTH C/O NVRA IMAGING NETWORK UNION SQUARE BLDG #1
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 203-264-7999
  • Fax: 203-264-7477
Mailing address:
  • Phone: 203-264-7999
  • Fax: 203-264-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number029230
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number029230
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number029230
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: