# 369 MEDICAL PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376141325
- **Authorized official:** MACK SULLIVAN MD (OWNER)
- **Authorized official phone:** (914) 395-3691

## Contact information

- **Practice address:** 369 WHITE PLAINS RD FL 2, EASTCHESTER, NY 10709-2805
- **Practice address phone:** (914) 395-3691
- **Mailing address:** 369 WHITE PLAINS RD, EASTCHESTER, NY 10709-2805
- **Mailing address phone:** (914) 369-3691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/13/2020
- **Last updated:** 10/17/2023