Healthcare Provider Details

I. General information

NPI: 1770647802
Provider Name (Legal Business Name): MARGARET MARIE BUSH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

1149 ORCHID CIR
BELLPORT NY
11713-3005
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3500
  • Fax:
Mailing address:
  • Phone: 631-317-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number209936
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number209936-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: