Healthcare Provider Details

I. General information

NPI: 1831103613
Provider Name (Legal Business Name): ROBERT-ARNE B SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

615 E 14TH ST APT 2D
NEW YORK NY
10009-3213
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9181
  • Fax:
Mailing address:
  • Phone: 212-465-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number212754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: