Individual
JUSTIN MICHEAL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
205 E LAUREL RD, STRATFORD, NJ 08084-1301
(856) 344-2315
Mailing address
205 E LAUREL RD, STRATFORD, NJ 08084-1301
(844) 542-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00553600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0714275
—
NJ
Enumeration date
11/20/2019
Last updated
02/11/2020
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