MEDICARE: MS. PATRICIA A O'SULLIVAN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2174007	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2174007	OTHER	NY	SPECIAL EDUCATION

General Provider Information

NPI Number	:	1588090104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A O'SULLIVAN M.S.

Provider Business Mailing Address
First Line	:	150 BURNS ST
Second Line	:	APT. 1F
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6150
Country	:	US
Telephone Number	:	646-361-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BURNS ST
Second Line	:	APT. 1F
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6150
Country	:	US
Telephone Number	:	646-361-5432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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