Provider Demographics
NPI:1871707034
Name:SULLIVAN, CAROLINE M (NP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:132 CROSBY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3363
Mailing Address - Country:US
Mailing Address - Phone:212-219-7716
Mailing Address - Fax:
Practice Address - Street 1:132 CROSBY ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3363
Practice Address - Country:US
Practice Address - Phone:212-219-7716
Practice Address - Fax:212-219-3744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-302970363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19064Medicare UPIN