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General NPI Number Information
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NPI Number | 1154930931
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Entity Type | Individual
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Provider Name | JOSHUA TIMOTHY SULLIVAN
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Gender | Male
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 43 NEW SCOTLAND AVE # MC-139
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City | ALBANY
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State | NY
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Zip | 12208-3478
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Country | US
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Telephone | 518-262-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 RIDGECROFT AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8010
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Country | US
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Telephone | 616-560-6453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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