Provider Demographics
NPI:1568829356
Name:PULASKI MEDICAL URGENT CARE, P.C
Entity Type:Organization
Organization Name:PULASKI MEDICAL URGENT CARE, P.C
Other - Org Name:PULASKI URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-415-3529
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-0074
Mailing Address - Country:US
Mailing Address - Phone:315-298-2273
Mailing Address - Fax:
Practice Address - Street 1:3858 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-2400
Practice Address - Country:US
Practice Address - Phone:315-298-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03297174Medicaid
NY03215529Medicaid
NY03215529Medicaid
NY03297174Medicaid