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General NPI Number Information
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NPI Number | 1679975692
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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 | 09/22/2014
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 1135 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-3642
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Country | US
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Telephone | 973-777-3286
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Fax | 973-777-0435
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Provider Business Mailing Address
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Address Line | 1135 CLIFTON AVE SUITE 206
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City | CLIFTON
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State | NJ
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Zip | 07013-3642
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Country | US
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Telephone | 973-777-3286
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Fax | 973-777-0435
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JESSICA SKOWRON
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Credential |
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Telephone | 973-777-3286
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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 | 25MA07277700
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License Number State | NJ
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