Individual
MACK LEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
369 WHITE PLAINS RD, EASTCHESTER, NY 10709-2805
(914) 395-3691
(914) 395-3693
Mailing address
369 WHITE PLAINS RD, EASTCHESTER, NY 10709-2805
(914) 395-3691
(914) 395-3693
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
203477-1
NY
207QG0300X
Geriatric Medicine (Family Medicine) Physician
203477
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
203477
NY
208D00000X
General Practice Physician
203477
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C5609
HEALTHNET
NY
Enumeration date
07/24/2006
Last updated
01/01/2026
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