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General NPI Number Information
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NPI Number | 1437203999
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Entity Type | Individual
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Provider Name | MARIA A. SULLIVAN M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 140 RIVERSIDE DR # 1- O
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City | NEW YORK
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State | NY
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Zip | 10024-2605
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Country | US
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Telephone | 212-678-9508
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Fax | 212-543-6018
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Provider Business Mailing Address
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Address Line | 4642 WALDO AVE
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City | BRONX
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State | NY
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Zip | 10471-3000
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Country | US
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Telephone | 718-548-1661
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Fax | 212-543-6018
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 194288
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License Number State | NY
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