Provider Demographics
NPI:1316978042
Name:SULLIVAN, JANET N (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:N
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2302
Mailing Address - Country:US
Mailing Address - Phone:914-576-7484
Mailing Address - Fax:
Practice Address - Street 1:303 S BROADWAY
Practice Address - Street 2:SUITE 321
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5413
Practice Address - Country:US
Practice Address - Phone:914-631-1611
Practice Address - Fax:914-631-1615
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062065207N00000X
NY208738207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0947891Medicaid
NY4H2711Medicare ID - Type Unspecified
OHSU0722381Medicare ID - Type Unspecified
NY0947891Medicaid