Provider Demographics
NPI:1699854992
Name:SELVARAJ&SULLIVAN LLP
Entity Type:Organization
Organization Name:SELVARAJ&SULLIVAN LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-980-2844
Mailing Address - Street 1:2 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2306
Mailing Address - Country:US
Mailing Address - Phone:914-980-2844
Mailing Address - Fax:914-238-4215
Practice Address - Street 1:2 JEFFREY LN
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-2306
Practice Address - Country:US
Practice Address - Phone:914-980-2844
Practice Address - Fax:914-238-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100066658Medicare PIN