Provider Demographics
NPI:1831841519
Name:O'SULLIVAN, BRIDGET (PA-C)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1754
Mailing Address - Country:US
Mailing Address - Phone:516-724-2969
Mailing Address - Fax:
Practice Address - Street 1:740 COUNTY ROAD 39A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5247
Practice Address - Country:US
Practice Address - Phone:631-638-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical