Paul J Sullivan

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

28067 Issued in NY

Practice address

11-12 Broadway Ave
Gloversville, NY 12078

Phone

(518) 725-4310

Fax

(518) 725-2556

NPI assigned

Sep 14, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Paul J Sullivan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1356824486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2H FULHAM RD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120656322",
            "telephone_number": "518-244-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11-12 BROADWAY AVE",
            "city": "GLOVERSVILLE",
            "state": "NY",
            "postal_code": "12078",
            "telephone_number": "518-725-4310",
            "fax_number": "518-725-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAUL",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "28067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "SULLIVAN",
            "middle_name": "J",
            "credential": "CASAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Robert J Stankes, RPH
• Dawn Marie Stuart, MSW
• Kiara R Stuart
• Michael A Sturgess, PHARMD
• Kevin Sudds
• Maruthi Madhav Sunkara, MD
• Paula M Sutton, RN
• Meagan E Sweeney, MHC
• SWTS Transportation LLC
• Zainul-Abideen Syed, MD

• Addiction (Substance Use Disorder) Counselor in Gloversville, NY
• Providers in Gloversville, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.