The insults came just a day after Mr Chavez called Bush "the devil" and a "tyrant" in a tirade at the United Nations General Assembly.
The Venezuelan leader resumed his attack as he promised extra oil supplies for poor New York families.
Hundreds flocked to see Mr Chavez speak at the Olivet Baptist church, lapping up his anti-Bush rhetoric and his gesture of help.
"Bush is an alcoholic, a sick man with a lot of hang-ups," declared the left-wing Venezuelan leader.
Mr Bush has acknowledged he was once a heavy drinker but gave up alcohol on his 40th birthday.
Mr Chavez also declared he "doesn't know anything about politics, he got there because of Daddy."
George Bush snr was US president from 1989 to 1993.
"The United States should choose a president with whom you can talk and work, not this gentleman who walks like John Wayne," he said.
At the UN General Assembly, Mr Chavez said "Yesterday the devil came here," referring to Mr Bush's speech 24 hours earlier.
"And it still smells of sulphur today, this table that I am now standing in front of," he said.
Mr Chavez then brought his hands together as if in prayer and looked up to the ceiling, prompting applause and some laughs.
Not amused
Washington's UN ambassador John Bolton dismissed Chavez's speech as a "comic strip approach to international affairs."
Former US President Bill Clinton seemed to share that view.
"Obviously I think he made a mistake to do it," said Mr Clinton. "He's not hurting us, just himself and his country."
Congressman Charles Rangel, a harsh critic of Mr Bush and Democrat who represents Harlem, strongly condemned Mr Chavez.
"I just want to make it abundantly clear to Hugo Chavez or any other president -- don't come to the United States ... and (do) not think that Americans do not feel offended when you offend our chief of state," he told US media.
"If there's any criticism of president Bush, it should be restricted to Americans whether they voted for him or not."
Many US media commentators said Mr Chavez's remarks were harsher than those of Iranian President President Mahmoud Ahmadinejad, an arch-rival of Mr Bush.
"Iran who? Venezuela takes the lead in a battle of anti-US soundbites," said The New York Times.
USA Today compared the Chavez speech to Soviet leader Nikita Khruschev's famous 1960 shoe-banging UN speech.
Comparisons were also made to Palestinian leader Yassir Arafat's 1974 UN speech, delivered with a pistol holster on his hip and an olive leaf in his hand.
Hezbollah cheers
Mr Chavez's comments scored a big hit with Lebanon's Iranian-backed militant group Hezbollah.
"Gracias Chavez," proclaimed large posters put up by Hezbollah activists in their Shiite stronghold of Beirut's southern suburbs.
They were posted on the streets on the eve of a "victory" rally following the group's war with Israel.
The portrait shows Mr Chavez in a red shirt and punching the air with a fist, and also calls for Israel "to be taken to court for its crimes."
More than 1,200 people were killed in Lebanon alone during the 34 day war which ended in mid-August.
Caracas pulled the Venezuelan charge d'affaires out of Israel in early August in protest against its operations in Lebanon.
At the time, Mr Chavez claimed that Israel "had lost its mind".