Basic Information
| Provider Information | |||||||||
| NPI: | 1285775932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | BERNARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 MILLWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144131957 | ||||||||
| FaxNumber: | 7182268144 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 GLENN ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106033254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144131957 | ||||||||
| FaxNumber: | 7182268144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 135140 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.