Individual
COOPER R BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 STATE ST, WATERTOWN, NY 13601-2839
(315) 755-1251
(315) 291-6601
Mailing address
324 COUNTY ROUTE 51 BLDG 1, MALONE, NY 12953-4502
(518) 651-2302
(518) 483-2242
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/30/2025
Last updated
10/30/2025
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