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General NPI Number Information
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NPI Number | 1629546734
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Entity Type | Individual
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Provider Name | PATRICK M SULLIVAN
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Gender | Male
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 80 HIGHLAND CROSS # 1
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2122
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Country | US
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Telephone | 201-370-7612
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Fax |
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Provider Business Mailing Address
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Address Line | 80 HIGHLAND CROSS # 1
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2122
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Country | US
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Telephone | 201-370-7612
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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