Edwin J Sullivan, DO FACOS

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MB25068 Issued in NJ

Practice address

449 B Market St
Suite B
Saddle Brook, NJ 07663-8941

Phone

(201) 843-7942

Fax

(201) 712-7902

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bergen Laparoscopic and General Surgery PA

  • Surgery Physician
  • Saddle Brook, NJ
  • NPI 1336185131
  NPD (past)
• Saddle Brook Medical Center PA

  • Urgent Care Clinic/Center
  • Saddle Brook, NJ
  • NPI 1982631883
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477580306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "449 B MARKET ST",
            "address_2": "SUITE B",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "076638941",
            "telephone_number": "201-843-7942",
            "fax_number": "201-712-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 B MARKET ST",
            "address_2": "SUITE B",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "076638941",
            "telephone_number": "201-843-7942",
            "fax_number": "201-712-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "EDWIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO FACOS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NJ",
            "license": "MB25068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1464906",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Patricia Spieker, LAC
• Spine & Rehabilitation Center of Saddle Brook
• Kerryn Michelle St. Andre, PT, DPT
• Starlight Home Care Agency, Inc
• Edward Joseph Suchora, D.M.D.
• Surgicore, LLC
• Surgistar Holdings LLC
• Lhiel Taga-Oc, OTR/L
• Brian Tanada, DPT
• Mahnaz Chand Tantawi, MD

• All providers in Saddle Brook, NJ
• Urology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.