Provider Demographics
NPI:1962912329
Name:BUSCH, COOPER VINCENT
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:VINCENT
Last Name:BUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1614
Mailing Address - Country:US
Mailing Address - Phone:315-360-5137
Mailing Address - Fax:
Practice Address - Street 1:71 BURWELL ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1614
Practice Address - Country:US
Practice Address - Phone:315-360-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPatient Transport