Healthcare Provider Details

I. General information

NPI: 1295502235
Provider Name (Legal Business Name): ALDEN BUSH DNP - NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 STATE ST FL 40
NEW YORK NY
10004-1547
US

IV. Provider business mailing address

17 STATE ST FL 40
NEW YORK NY
10004-1547
US

V. Phone/Fax

Practice location:
  • Phone: 518-652-1352
  • Fax: 518-450-6484
Mailing address:
  • Phone: 518-652-1352
  • Fax: 518-450-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALDEN A BUSH
Title or Position: SOLE MEMBER/OWNER
Credential: DNP, MPH
Phone: 518-652-1352