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General NPI Number Information
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NPI Number | 1184783839
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Entity Type | Organization
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Legal Business Name | SULLIVAN UROLOGIC ASSOCIATES PLLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1987 STATE RT 52E COLONIAL SQUARE MALL SUITE 4
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City | LIBERTY
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State | NY
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Zip | 12754-8316
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Country | US
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Telephone | 845-292-4000
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Fax | 845-292-4001
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Provider Business Mailing Address
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Address Line | PO BOX 276
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City | FERNDALE
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State | NY
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Zip | 12734-0276
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Country | US
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Telephone | 845-292-4000
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Fax | 845-292-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEF RICHTER
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Credential | MD
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Telephone | 845-292-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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