Provider Demographics
NPI:1477573038
Name:SULE, SACHIN (MD)
Entity Type:Individual
Prefix:
First Name:SACHIN
Middle Name:
Last Name:SULE
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 1:670 GLADES RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-955-2570
Mailing Address - Fax:
Practice Address - Street 1:670 GLADES RD STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6464
Practice Address - Country:US
Practice Address - Phone:561-955-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64462207R00000X
NY001885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3185130OtherOXFORD
NY00000079827OtherGHI HMO
NY7516576OtherAETNA PPO
NYHEALTHNETOther5C5335
NY02659401Medicaid
NY2589996OtherGHI PPO
NY4129332OtherMVP
NY98S131OtherBCBS
NYP00182434OtherRAILROAD MEDICARE
NY1499327OtherAETNA HMO
NY218AU05271Medicare PIN