Provider Demographics
NPI:1972920650
Name:RUSH, ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CORLIES AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4800
Mailing Address - Country:US
Mailing Address - Phone:201-522-3205
Mailing Address - Fax:
Practice Address - Street 1:1900 CORLIES AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4800
Practice Address - Country:US
Practice Address - Phone:201-522-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS00003800T291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory