Provider Demographics
NPI:1972389989
Name:SULLIVAN SAFE MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:SULLIVAN SAFE MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:MACK LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-395-3691
Mailing Address - Street 1:369 WHITE PLAINS RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-2805
Mailing Address - Country:US
Mailing Address - Phone:914-395-3691
Mailing Address - Fax:
Practice Address - Street 1:369 WHITE PLAINS RD FL 2
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-2805
Practice Address - Country:US
Practice Address - Phone:914-395-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty