Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 206629 | NY |
NPI | 1316943863 |
---|---|
Provider Name | Michael W Sullivan |
First Address | Snyder, NY 14226-3800 |
Second Address | Snyder, NY 14226-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F52070 | (02) | NY |