Provider Demographics
NPI:1629546734
Name:SULLIVAN, PATRICK M
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HIGHLAND CROSS # 1
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2122
Mailing Address - Country:US
Mailing Address - Phone:201-370-7612
Mailing Address - Fax:
Practice Address - Street 1:80 HIGHLAND CROSS # 1
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2122
Practice Address - Country:US
Practice Address - Phone:201-370-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty