# MACK LEE SULLIVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1881616068
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 203477-1 | NY | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | 203477 | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 203477 | NY | Yes |
| 208D00000X | General Practice Physician | 203477 | NY | — |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 01/01/2026