Provider Demographics
NPI:1699867382
Name:BUSHAY, STEPHEN L (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:BUSHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1877
Mailing Address - Country:US
Mailing Address - Phone:609-569-1900
Mailing Address - Fax:609-569-1404
Practice Address - Street 1:1601 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1877
Practice Address - Country:US
Practice Address - Phone:609-569-1900
Practice Address - Fax:609-569-1404
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07709900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223488002OtherTIN
NJ083838SLLMedicare PIN
NJ083838SBVMedicare PIN
NJI7597Medicare UPIN
NJ083838QLLMedicare PIN
NJ083838PKNMedicare PIN