MACK LEE SULLIVAN (NPI# 1881616068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881616068 |
| Entity Type | Individual |
| Full Name | MACK LEE SULLIVAN |
| Credential | M.D. |
| Practice Address |
150 Lake Ave Tuckahoe NY 10707-3306 |
| Mailing Address |
369 White Plains Rd Eastchester NY 10709-2805 |
| Practice Telephone | 9143953691 |
| Practice Fax Number | 9143953693 |
| Mailing Telephone | 9143953691 |
| Mailing Fax Number | 9143953693 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2015-08-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 203477-1 | NY | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | 203477 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | HEALTHNET | 5C5609 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780683151 | Mack Hugh Sullivan Jr. | Plastic Surgery | 44199 Dequindre Rd., Suite 518, Troy, MI 48085 | 2005-07-19 |
| Street Address |
150 LAKE AVE |
| City | TUCKAHOE |
| State | NY |
| Zip Code | 10707-3306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114164225 | Fitness & Recovery Medical Practice, PC | Family Medicine | 150 Lake Ave, Tuckahoe, NY 10707-3306 | 2009-01-12 |
| 1801064167 | Fitness & Recovery, LLC | Emergency Medicine | 150 Lake Ave, Tuckahoe, NY 10707-3306 | 2008-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729761 | Mariana Gutierrez | Registered Nurse | 1 Park Avenue Apt #j1, Tuckahoe, NY 10707 | 2020-04-22 |
| 1063774495 | Kristy B Breckenridge Schurr | Early Intervention Provider Agency | 7 Oak Avenue, 2, Tuckahoe, NY 10707 | 2012-06-12 |
| 1669797650 | Meghan Elizabeth Mcauley | Speech-Language Pathologist | 22 Underhill Street, Tuckahoe, NY 10707 | 2010-04-01 |
| 1215187489 | Thomas Aquinas Fischer | Psychologist | 111 Lake Avenue Suite 4, Tuckahoe, NY 10707 | 2008-09-24 |
| 1285829978 | Kartika Khanna | Pediatrics | 107 W Fourth St, Mt Vernon Neighborhood Health Centre,inc, Mt Vernon, NY 10707 | 2007-09-06 |
| 1891917886 | Clifford Joseph Cozolino | Chiropractor | 335 Columbus Ave., Tuckahoe, NY 10707 | 2007-05-02 |
| 1174683742 | Ellen Donna Teplitz | Dermatology | 1 Elm Street Parkway Plaza Medical Center, Suite 2b, Tuckahoe, NY 10707 | 2006-12-12 |
| 1427023209 | Jayne Fanta Betts | Nurse Practitioner | 375 White Plains Rd., Minute Clinic of New York Inside Cvs Pharmacy, Eastchester, NY 10707 | 2006-02-23 |
| 1033679592 | Alejandro Diaz | Counselor | 68 Main St, Suite 340, Tuckahoe, NY 10707 | 2019-03-21 |
| 1306200191 | Susan Scharf | Social Worker | 65 Main Street, Andrus Early Learning Center, Tuckahoe, NY 10707 | 2016-04-08 |
| Find all providers in zip 10707 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333466 | Rita Mello | Emergency Medicine | 10 Maplemoor Ln, White Plains, NY 10605-4704 | 2020-10-11 |
| 1891318754 | Mat Medical Associates, P.C. | Emergency Medicine | 565 Route 25a Ste 4, Miller Place, NY 11764-2663 | 2020-05-26 |
| 1508488040 | Madhok Medical Corporation | Emergency Medicine | 555 Madison Ave Fl 20, New York, NY 10022-3301 | 2020-05-07 |
| 1134749658 | Kenneth Yaboh | Emergency Medicine | 1000 Cherrywood Dr, Baldwin, NY 11510-5009 | 2020-04-24 |
| 1487273777 | Rosheen Teresa Mcelroy | Emergency Medicine | 70 Remsen St # 2ab, Brooklyn, NY 11201-3432 | 2020-04-16 |
| 1477180479 | Taj Medical Pllc | Emergency Medicine | 10925 111th St, South Ozone Park, NY 11420-1015 | 2020-03-27 |
| 1013552181 | Health Quest Medical Practice, PC | Emergency Medicine | 1240 Ulster Avenue, Kingston, NY 12401 | 2019-11-13 |
| 1346892155 | Jonathan Pezhmannia | Emergency Medicine | 2a Cortlandt St, New York, NY 10007-3104 | 2019-07-11 |
| 1659939700 | Richard Edward Smith Medicine PC | Emergency Medicine | 81 Miller Rd Ste 600, S Schodack, NY 12033-4042 | 2019-06-04 |
| 1295392553 | Johnny Slade | Emergency Medicine | 11 Bridge Rd, East Setauket, NY 11733 | 2019-05-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.