Provider Demographics
NPI:1508834151
Name:SULLIVAN, JAMES PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HIGHWAY 35
Mailing Address - Street 2:BLDG C STE 312
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1010
Mailing Address - Country:US
Mailing Address - Phone:732-974-8200
Mailing Address - Fax:732-974-0190
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:BLDG C STE 312
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-8200
Practice Address - Fax:732-974-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD2271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMD2271OtherLICENSE
NJD06605800OtherCDS
NJ6920101Medicaid
NJBS4457520OtherDEA
NJD06605800OtherCDS
NJSU853224Medicare ID - Type UnspecifiedPODIATRY