Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | SC003899L | PA |
Y | 213ES0131X | Foot Surgery | 25MD00267000 | NJ |
NPI | 1417953647 |
---|---|
Provider Name | Paul Edward Sullivan |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8925704 | (05) | NJ |
U55737 | (02) | PA |