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General NPI Number Information
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NPI Number | 1215126065
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Entity Type | Organization
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Legal Business Name | GREGORY F. SULLIVAN , M.D., F.A.C.C., P.A.
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 1117 ROUTE 46 SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07013-2449
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Country | US
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Telephone | 973-779-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 ROUTE 46 SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07013-2449
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Country | US
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Telephone | 973-779-1221
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. GREGORY FRANICS SULLIVAN II
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Credential | PH.D., M.B.A.
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Telephone | 617-230-9317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 25MA02285700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA02285700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | NJ
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