Provider Demographics
NPI:1831458421
Name:O'SULLIVAN, CHRISTOPHER E (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:E
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-698-1552
Mailing Address - Fax:
Practice Address - Street 1:400 HORSEBLOCK RD
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-698-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020494225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist