MEDICARE: COOPER VINCENT BUSCH

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	2279P4000X	Patient Transport Registered Respiratory Therapist

General Provider Information

NPI Number	:	1962912329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COOPER VINCENT BUSCH

Provider Business Mailing Address
First Line	:	71 BURWELL ST
Second Line	:
City	:	LITTLE FALLS
State	:	NY
Zip	:	13365-1614
Country	:	US
Telephone Number	:	315-360-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 BURWELL ST
Second Line	:
City	:	LITTLE FALLS
State	:	NY
Zip	:	13365-1614
Country	:	US
Telephone Number	:	315-360-5137
Fax Number	:

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

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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Directions to “ COOPER VINCENT BUSCH ” Practice Location

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