Sullivan, Mark

Sullivan, Mark is an individual health care provider with primary practice located at 1 Tallow Wood Dr , Clifton Park NY 12065-2807. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Sullivan, Mark can be contacted via phone (518) 373-4444.

Contact Information

Primary practice address
1 Tallow Wood Dr Clifton Park NY 12065-2807
Phone: (518) 373-4444
Fax: (518) 373-0663
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004099 New York

Profile Details

NPI number 1821046921
LBN Legal business name Sullivan, Mark
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Dec 7th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821046921 NPPES
New York MEDICAID 02347280

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