Provider Demographics
NPI:1184783839
Name:SULLIVAN UROLOGIC ASSOCIATES PLLC
Entity type:Organization
Organization Name:SULLIVAN UROLOGIC ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-292-4000
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-0276
Mailing Address - Country:US
Mailing Address - Phone:845-292-4000
Mailing Address - Fax:845-292-4001
Practice Address - Street 1:1987 STATE RT 52E
Practice Address - Street 2:COLONIAL SQUARE MALL SUITE 4
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8316
Practice Address - Country:US
Practice Address - Phone:845-292-4000
Practice Address - Fax:845-292-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty