Healthcare Provider Details

I. General information

NPI: 1598766131
Provider Name (Legal Business Name): GREGORY H. BUSCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 ROUTE 38 SUITE 6
LUMBERTON NJ
08048-2939
US

IV. Provider business mailing address

5 EVES DR SUITE 120 A
MARLTON NJ
08053-3135
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-2100
  • Fax: 609-267-6921
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MB08068700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08068700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: