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General NPI Number Information
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NPI Number | 1861546517
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Entity Type | Individual
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Provider Name | ANDREW JOSEPH SULLIVAN JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19 W 33RD ST A
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City | BAYONNE
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State | NJ
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Zip | 07002-3916
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Country | US
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Telephone | 201-437-9098
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Fax | 201-436-1595
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Provider Business Mailing Address
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Address Line | 25 MONTVIEW AVE
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City | SHORT HILLS
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State | NJ
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Zip | 07078-2034
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Country | US
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Telephone | 973-376-7618
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Fax | 973-376-0073
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 9314
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License Number State | NJ
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