Healthcare Provider Details

I. General information

NPI: 1285775932
Provider Name (Legal Business Name): TIMOTHY BERNARD SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 CENTRAL PARK W APT 1A
NEW YORK NY
10024-4111
US

IV. Provider business mailing address

530 MILLWOOD RD
MOUNT KISCO NY
10549-3701
US

V. Phone/Fax

Practice location:
  • Phone: 914-413-1957
  • Fax: 718-226-8144
Mailing address:
  • Phone: 914-413-1957
  • Fax: 718-226-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number135140
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: