Individual
BRIDGET ANNE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
630 W 168TH ST, NEW YORK, NY 10032-3725
(212) 305-2500
Mailing address
225 N GROVE ST, VALLEY STREAM, NY 11580-3411
(516) 578-7120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
029067
NY
Other
Enumeration date
10/10/2022
Last updated
10/10/2022
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