Healthcare Provider Details

I. General information

NPI: 1972920650
Provider Name (Legal Business Name): ROBERT RUSH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CORLIES AVE FIRST FLOOR
NEPTUNE NJ
07753-4800
US

IV. Provider business mailing address

1900 CORLIES AVE FIRST FLOOR
NEPTUNE NJ
07753-4800
US

V. Phone/Fax

Practice location:
  • Phone: 201-522-3205
  • Fax:
Mailing address:
  • Phone: 201-522-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number25MS00003800T
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: