Provider Demographics
NPI:1386852341
Name:SULLIVAN, ALISON ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:ELIZABETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 CRYSTAL RUN RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7009
Mailing Address - Country:US
Mailing Address - Phone:845-333-7800
Mailing Address - Fax:845-333-7696
Practice Address - Street 1:75 CRYSTAL RUN RD STE 135
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7009
Practice Address - Country:US
Practice Address - Phone:845-333-7800
Practice Address - Fax:845-333-7696
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231050208000000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2226620581Medicare PIN