Provider Demographics
NPI:1144660754
Name:SULLIVAN, BRENDAN JAMES (MD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JAMES
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 LIBERTY PLZ STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1404
Mailing Address - Country:US
Mailing Address - Phone:917-261-4414
Mailing Address - Fax:917-261-4420
Practice Address - Street 1:80 MAIDEN LN STE 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4811
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:917-261-4420
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63815207R00000X
MDD87163207R00000X
IL036150346207R00000X
MA272839207R00000X
MA256259207R00000X
NJ25MA10635600207R00000X
NY295780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine