Shane Bush, PHD is a
Clinical Neuropsychologist based in Lake Ronkonkoma, New York. Shane Bush is licensed to practice in New York (license number 012998) and his current practice location is
290 Hawkins Ave, Suite B, Lake Ronkonkoma, New York. He can be reached at his office (for appointments etc.) via phone at
(631) 334-7884.
NPI number for Shane Bush is 1003868514 and his current mailing address is 290 Hawkins Ave, Suite B, Lake Ronkonkoma, New York. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1003868514.
Healthcare Provider's Profile
| Full Name | Shane Bush |
|---|
| Gender | Male |
|---|
| Speciality | Clinical Neuropsychologist |
|---|
| Location | 290 Hawkins Ave, Lake Ronkonkoma, New York |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1003868514
- Provider Enumeration Date: 05/16/2006
- Last Update Date: 07/18/2007
Medical Identifiers
Medical identifiers for Shane Bush such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1003868514 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 012998-2 (New York) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 012998 (New York) | Primary |
| 103TR0400X | Psychologist - Rehabilitation | 012998 (New York) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shane Bush is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shane Bush, PHD
290 Hawkins Ave, Suite B,
Lake Ronkonkoma, NY 11779-9600
Ph: (631) 334-7884 | Shane Bush, PHD
290 Hawkins Ave, Suite B,
Lake Ronkonkoma, NY 11779-9600
Ph: (631) 334-7884 |
Reviews and Comments