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General NPI Number Information
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NPI Number | 1437103090
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Entity Type | Individual
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Provider Name | SEAN C OSULLIVAN PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 111 CLOCK TOWER CMNS NORTHERN MEDICAL GROUP, PLLC
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City | BREWSTER
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State | NY
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Zip | 10509-4055
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Country | US
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Telephone | 845-592-4915
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Fax | 845-592-4914
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Provider Business Mailing Address
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Address Line | 159 BARNEGAT RD NORTHERN MEDICAL GROUP, PLLC
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-5401
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Country | US
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Telephone | 845-592-4915
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 009491
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License Number State | NY
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