Individual
JOHN K SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
76 VETERANS AVE, BATH, NY 14810
(607) 664-4000
(607) 664-4791
Mailing address
418 N MAIN ST, PENN YAN, NY 14527-1070
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
166152
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J400006577
PTAN-NORTH MEDICAL, PC
NY
Enumeration date
10/12/2006
Last updated
09/19/2025
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