Provider Demographics
NPI:1992143671
Name:O'SULLIVAN, EILISH T (PT)
Entity type:Individual
Prefix:MS
First Name:EILISH
Middle Name:T
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E 79TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1573
Mailing Address - Country:US
Mailing Address - Phone:617-721-4060
Mailing Address - Fax:
Practice Address - Street 1:528 E 79TH ST
Practice Address - Street 2:APT 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1573
Practice Address - Country:US
Practice Address - Phone:617-721-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist