Provider Demographics
NPI:1508900531
Name:DR PAUL E SULLIVAN
Entity Type:Organization
Organization Name:DR PAUL E SULLIVAN
Other - Org Name:BURLINGTON MERCER PODIATRY ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-890-6544
Mailing Address - Street 1:2089 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3416
Mailing Address - Country:US
Mailing Address - Phone:609-890-6544
Mailing Address - Fax:609-890-6588
Practice Address - Street 1:2089 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3416
Practice Address - Country:US
Practice Address - Phone:609-324-2900
Practice Address - Fax:609-324-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00267000213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV07210Medicare UPIN
NJU55737Medicare UPIN
NJ098055Medicare PIN