MEDICARE: NICHOLAS E RUSH RDN, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86089838	NY

General Provider Information

NPI Number	:	1235765389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS E RUSH RDN, CDN

Provider Business Mailing Address
First Line	:	65 W 106TH ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3834
Country	:	US
Telephone Number	:	901-238-8466
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 W 106TH ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3834
Country	:	US
Telephone Number	:	901-238-8466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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