Healthcare Provider Details

I. General information

NPI: 1265171243
Provider Name (Legal Business Name): SEAN RUSH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

13 N HARTFORD AVE
ATLANTIC CITY NJ
08401-3512
US

V. Phone/Fax

Practice location:
  • Phone: 888-569-1000
  • Fax:
Mailing address:
  • Phone: 609-348-1161
  • Fax: 609-348-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB13123900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: