Provider Demographics
NPI:1659468528
Name:SULLIVAN, AUBIN GAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUBIN
Middle Name:GAY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W 57TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3310
Mailing Address - Country:US
Mailing Address - Phone:212-799-6700
Mailing Address - Fax:212-799-4533
Practice Address - Street 1:152 W 57TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3310
Practice Address - Country:US
Practice Address - Phone:212-799-6700
Practice Address - Fax:212-799-4533
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
NY024864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ06U11Medicare PIN