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General NPI Number Information
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NPI Number | 1831103613
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Entity Type | Individual
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Provider Name | ROBERT-ARNE B SULLIVAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 12/24/2008
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 718-226-9181
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Fax |
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Provider Business Mailing Address
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Address Line | 615 E 14TH ST APT 2D
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City | NEW YORK
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State | NY
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Zip | 10009-3213
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Country | US
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Telephone | 212-465-6704
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 212754
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License Number State | NY
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