MEDICARE: DR. JOHN JOSEPH RUSHTON JR. PH.D.

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	207K00000X	Allergy & Immunology Physician	RUSHJ2	NY
2	207SG0203X	Clinical Molecular Genetics Physician	RUSHJ2	NY
3	207SG0207X	Medical Biochemical Genetics	RUSHJ2	NY
4	207ZM0300X	Medical Microbiology Physician	RUSHJ2	NY

General Provider Information

NPI Number	:	1437908530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH RUSHTON JR. PH.D.

Provider Business Mailing Address
First Line	:	55 AMHERST VILLA RD STE 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-1400
Country	:	US
Telephone Number	:	800-960-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 AMHERST VILLA RD STE 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-1400
Country	:	US
Telephone Number	:	800-960-1080
Fax Number	:

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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