Provider Demographics
NPI:1558799395
Name:MACK LEE SULLIVAN MD MS URGENT MEDICAL CARE OF EASTCHESTER, PLLC
Entity Type:Organization
Organization Name:MACK LEE SULLIVAN MD MS URGENT MEDICAL CARE OF EASTCHESTER, PLLC
Other - Org Name:EASTCHESTER URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:MACK LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-395-3691
Mailing Address - Street 1:369 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-2805
Mailing Address - Country:US
Mailing Address - Phone:914-337-8743
Mailing Address - Fax:914-337-8748
Practice Address - Street 1:369 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-2805
Practice Address - Country:US
Practice Address - Phone:914-337-8743
Practice Address - Fax:914-337-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190101-1261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care