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General NPI Number Information
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NPI Number | 1114164225
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Entity Type | Organization
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Legal Business Name | FITNESS & RECOVERY MEDICAL PRACTICE, PC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 369 WHITE PLAINS RD STE B
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City | EASTCHESTER
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State | NY
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Zip | 10709-2805
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Country | US
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Telephone | 914-395-3691
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Fax | 914-395-3693
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Provider Business Mailing Address
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Address Line | 369 WHITE PLAINS RD STE B
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City | EASTCHESTER
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State | NY
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Zip | 10709-2805
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Country | US
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Telephone | 914-395-3691
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Fax | 914-395-3693
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Authorized Official
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Title or Position | M.D.
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Name | MACK LEE SULLIVAN
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Credential |
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Telephone | 914-395-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 203477
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 203477
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License Number State | NY
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