Organization
369 MEDICAL PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACK SULLIVAN MD (OWNER)
(914) 395-3691
Entity
Organization
Contact information
Practice address
369 WHITE PLAINS RD FL 2, EASTCHESTER, NY 10709-2805
(914) 395-3691
Mailing address
369 WHITE PLAINS RD, EASTCHESTER, NY 10709-2805
(914) 369-3691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
10/13/2020
Last updated
10/17/2023
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