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General NPI Number Information
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NPI Number | 1497024178
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Entity Type | Organization
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Legal Business Name | RICHARD J SULLIVAN, M.D., P.C.
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 7904 TURIN RD
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City | ROME
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State | NY
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Zip | 13440-1933
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Country | US
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Telephone | 315-336-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 7904 TURIN RD PO BOX 4440
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City | ROME
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State | NY
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Zip | 13440-1933
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Country | US
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Telephone | 315-336-3400
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Fax |
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | DR. RICHARD J SULLIVAN
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Credential | M.D.
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Telephone | 315-336-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 116001-1
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License Number State | NY
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