MEDICARE: DR. TIMOTHY PATRICK SULLIVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	25MA03246800	NJ

General Provider Information

NPI Number	:	1154408011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY PATRICK SULLIVAN MD

Provider Business Mailing Address
First Line	:	19 N RIVERS EDGE DR
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1710
Country	:	US
Telephone Number	:	732-842-9459
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 N RIVERS EDGE DR
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1710
Country	:	US
Telephone Number	:	732-842-9459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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