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General NPI Number Information
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NPI Number | 1578109245
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Entity Type | Organization
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Legal Business Name | ALLAN BUSH
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 60 N PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4159
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Country | US
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Telephone | 516-850-6040
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Fax | 516-871-4371
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Provider Business Mailing Address
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Address Line | 60 N PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4159
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Country | US
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Telephone | 516-850-6040
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Fax | 516-871-4371
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KERRY CARLEY-BUSH
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Credential |
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Telephone | 516-641-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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