Provider Demographics
NPI:1073601092
Name:BESSIE SULLIVAN MD PA
Entity Type:Organization
Organization Name:BESSIE SULLIVAN MD PA
Other - Org Name:BESSIE M. SULLIVAN, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BESSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-753-1133
Mailing Address - Street 1:35-37 PROGRESS STREET
Mailing Address - Street 2:SUITE A2
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-753-1133
Mailing Address - Fax:908-753-1294
Practice Address - Street 1:35-37 PROGRESS STREET
Practice Address - Street 2:SUITE A2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-753-1133
Practice Address - Fax:908-753-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1448Medicare ID - Type Unspecified
NJ001448Medicare PIN