Organization
JAY F SULLIVAN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY FREDERICK SULLIVAN (MD)
(315) 298-2768
Entity
Organization
Contact information
Practice address
4882B NORTH JEFFERSON ST, PULASKI, NY 13142
(315) 298-2768
Mailing address
4882B NORTH JEFFERSON ST, PULASKI, NY 13142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
169461
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020708301
UNIVERA
NY
05
—
01538238
—
NY
01
—
138562
CIGNA
NY
01
—
169461-1W
WORKERS COMPENSATION
NY
01
—
5939163
AETNA
NY
01
—
691259
MVP
NY
01
—
799222
AETNA HMO
NY
Enumeration date
03/08/2007
Last updated
08/22/2020
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