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General NPI Number Information
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NPI Number | 1972920650
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Entity Type | Individual
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Provider Name | ROBERT RUSH PHD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 1900 CORLIES AVE FIRST FLOOR
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City | NEPTUNE
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State | NJ
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Zip | 07753-4800
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Country | US
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Telephone | 201-522-3205
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 CORLIES AVE FIRST FLOOR
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City | NEPTUNE
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State | NJ
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Zip | 07753-4800
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Country | US
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Telephone | 201-522-3205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 25MS00003800T
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License Number State | NJ
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