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General NPI Number Information
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NPI Number | 1417227562
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Entity Type | Organization
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Legal Business Name | STANFORD N. SULLUM MD PLLC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 1136 5TH AVE 1B
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City | NEW YORK
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State | NY
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Zip | 10128-0122
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Country | US
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Telephone | 212-876-4630
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Fax | 212-876-3478
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Provider Business Mailing Address
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Address Line | 1136 5TH AVE 1B
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City | NEW YORK
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State | NY
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Zip | 10128-0122
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Country | US
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Telephone | 212-876-4630
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Fax | 212-876-3478
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANFORD N SULLUM
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Credential | M.D.
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Telephone | 212-876-4630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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