| Doctor Name: | JOHN SULLIVAN |
| NPI Number: | 1417031220 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 001517 |
| Business Practice Address: | Community Care Schodack 77 Miller Road, Suite 1 Castleton, NY - 12033 |
| Business Phone Number: | 5184772167 |
| Business Fax Number: | |
| Mailing Address: | 711 Troy Schenectady Rd, Suite 201 LATHAM |
| State: | NY |
| Postal Code: | 121102442 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 001517 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |