Healthcare Provider Details

I. General information

NPI: 1962769794
Provider Name (Legal Business Name): CLARE BUSH ADDIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 JAMES ST STE 1G
MORRISTOWN NJ
07960-6348
US

IV. Provider business mailing address

105 OLD CHESTER RD
ESSEX FELLS NJ
07021-1625
US

V. Phone/Fax

Practice location:
  • Phone: 973-540-9393
  • Fax:
Mailing address:
  • Phone: 228-596-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA12967500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: