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General NPI Number Information
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NPI Number | 1538316310
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Entity Type | Organization
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Legal Business Name | BRENDAN P SULLIVAN MD FACC LLC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 265 ACKERMAN AVE SUITE 203
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4200
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Country | US
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Telephone | 201-445-8820
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Fax | 201-445-8850
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Provider Business Mailing Address
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Address Line | 183 LINCOLN AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4105
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Country | US
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Telephone | 201-612-7893
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Fax | 201-857-8460
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. BRENDAN P SULLIVAN
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Credential | MD
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Telephone | 973-779-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA072777
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License Number State | NJ
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