Individual
CHRISTINE ELIZABETH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
49 WEDGEWOOD LN, WANTAGH, NY 11793-1204
(516) 735-8601
Mailing address
49 WEDGEWOOD LN, WANTAGH, NY 11793-1204
(516) 735-8601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
527533111
NY
174400000X
Specialist
Primary
704648131
NY
Other
Enumeration date
02/11/2014
Last updated
02/11/2014
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