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General NPI Number Information
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NPI Number | 1568829356
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Entity Type | Organization
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Legal Business Name | PULASKI MEDICAL URGENT CARE, P.C
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 3858 STATE ROUTE 13
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City | PULASKI
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State | NY
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Zip | 13142-2400
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Country | US
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Telephone | 315-298-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 74
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City | PULASKI
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State | NY
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Zip | 13142-0074
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Country | US
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Telephone | 315-298-2273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY F SULLIVAN
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Credential | MD
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Telephone | 315-415-3529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 169461
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License Number State | NY
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