Stanford Norman Sullum, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

120964 Issued in NY

Practice address

1136 5TH Ave
1B
New York, NY 10128

Phone

(212) 876-4630

Fax

(212) 876-3478

NPI assigned

Aug 25, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2015 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Stanford N. Sullum MD PLLC

  • Gynecology Physician
  • New York, NY
  • NPI 1417227562
  NPD (past) Authorized official
• Jamal Rahaman GYN Oncologist PLLC

  • Gynecologic Oncology Physician
  • New York, NY
  • NPI 1184945578
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477660165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 5TH AVE",
            "address_2": "1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10128",
            "telephone_number": "212-876-4630",
            "fax_number": "212-876-3478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 5TH AVE",
            "address_2": "1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10128",
            "telephone_number": "212-876-4630",
            "fax_number": "212-876-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLUM",
        "first_name": "STANFORD",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "120964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Bernard Sullivan, M.D.
• Timothy Joseph Sullivan
• Tom M Sullivan, D.C.
• William B. Sullivan, N.P.
• Joshua Sullum, M.D.
• Joshtin Dale Ordona Sulse
• Vincent Michael Sulsona
• Yardena Sultan-Reisler
• Abiwaqqas Sultan
• Azmina Sultan, PT

• Obstetrics & Gynecology Physician in New York, NY
• Providers in New York, NY by specialty
• Obstetrics & Gynecology Physician in New York

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.