369 Medical Practice PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

369 MEDICAL PRACTICE PC

Practice address

369 White Plains Rd FL 2
Eastchester, NY 10709-2805

Phone

(914) 395-3691

NPI assigned

Oct 13, 2020

Organization subpart

No

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

Authorized official

Name

Mack Sullivan, MD

Title

Owner

Phone

(914) 395-3691

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1376141325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-369-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD FL 2",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-395-3691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "189 US Highway 46",
            "address_purpose": "LOCATION",
            "city": "Saddle Brook",
            "state": "NJ",
            "postal_code": "076636215",
            "country_code": "US",
            "telephone_number": "914-369-3691",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "369 MEDICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-395-3691",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A1 Big Apple Coordination
• Luba Abramsky, PHD
• Leslie Ellen Ackerman, PSY.D.
• Aderonke Adeniyi
• Judith Adjei, FNP-BC

• Physical Medicine & Rehabilitation Physician in Eastchester, NY
• Providers in Eastchester, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.