Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X008928-1 | NY |
NPI | 1467463232 |
---|---|
Provider Name | Dr. Mark L. Bushee |
First Address | Fishkill, NY 12524-3250 |
Second Address | Fishkill, NY 12524-3250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/11/2018 |