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Individual
MACK LEE SULLIVAN
Active
Individual
MACK LEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
203477-1
NY
207QG0300X
Geriatric Medicine (Family Medicine) Physician
203477
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
203477
NY
208D00000X
General Practice Physician
203477
NY
Other
Enumeration date
07/24/2006
Last updated
01/01/2026
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