Provider Demographics
NPI:1215918941
Name:RUSH, DAWN P (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:P
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-0309
Mailing Address - Country:US
Mailing Address - Phone:914-962-0684
Mailing Address - Fax:914-962-0415
Practice Address - Street 1:2649 STRANG BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2939
Practice Address - Country:US
Practice Address - Phone:914-962-0684
Practice Address - Fax:914-962-0415
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGO6360Medicare UPIN