Provider Demographics
NPI:1043582372
Name:RULON-BUSCH, LINDA M (MA,SPED,TSHH)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:RULON-BUSCH
Suffix:
Gender:F
Credentials:MA,SPED,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1925
Mailing Address - Country:US
Mailing Address - Phone:631-581-5029
Mailing Address - Fax:631-277-8597
Practice Address - Street 1:250 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1925
Practice Address - Country:US
Practice Address - Phone:631-581-5029
Practice Address - Fax:631-277-8597
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY764216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst