Healthcare Provider Details

I. General information

NPI: 1679569073
Provider Name (Legal Business Name): ELIZABETH JEANNE SULAVIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH JEANNE GALLAGHER NP

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 FULTON AVE SECOND FL
BRONX NY
10456
UM

IV. Provider business mailing address

4209 28TH ST # CN-48
LONG ISLAND CITY NY
11101-4130
US

V. Phone/Fax

Practice location:
  • Phone: 347-396-6299
  • Fax:
Mailing address:
  • Phone: 347-396-6299
  • Fax: 347-396-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420721-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: