Provider Demographics
NPI:1710994116
Name:SULLIVAN, RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:258 HALSTEAD AVE
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-0022
Mailing Address - Country:US
Mailing Address - Phone:914-681-1155
Mailing Address - Fax:
Practice Address - Street 1:41 E POST RD
Practice Address - Street 2:WHITE PLAINS HOSPITAL
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4607
Practice Address - Country:US
Practice Address - Phone:914-681-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259059207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400071099Medicare PIN
NYG64956Medicare UPIN