Provider Demographics
NPI:1417944562
Name:SULLIVAN, TIMOTHY P (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MADISON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-267-1113
Mailing Address - Fax:973-267-0719
Practice Address - Street 1:131 MADISON AVE STE 130
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-267-1113
Practice Address - Fax:973-267-0719
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05297600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0136332000OtherAMERIHEALTH
KY0K2236OtherHEALTHNET
NJ15240OtherUNIVERSITY HEALTH PLANS
TX0004259606OtherAETNA
PA7731618OtherCIGNA
CTIS471OtherOXFORD
NJA63760Medicare UPIN
TX0004259606OtherAETNA
NJ441491Medicare PIN