Dr Mack Sullivan Telemedicine 1101 PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DR MACK SULLIVAN TELEMEDICINE 1101 PC

Practice address

369 White Plains Rd
Eastchester, NY 10709-2805

Phone

(914) 395-3691

NPI assigned

Aug 20, 2026

Organization subpart

No

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

Authorized official

Name

Mack Lee Sullivan, MD

Title

Medical Director

Phone

(914) 395-3691

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1787184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787184000000",
    "number": "1669388443",
    "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": "914-395-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-395-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MACK SULLIVAN TELEMEDICINE 1101 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-20",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MACK",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "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": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staci F Davis, LMSW
• Delta Medical Services P.C
• Ruth E Derosa, LCMS
• Kimberly Dimarino
• Stefanie Dorman, PSYD
• Dr. Angela Reiter, PSYD, PC
• Edwin Duran, FNP
• Debabrata Dutta
• Eastchester Pediatric Medical GRP
• Eastchester Ufsd

• Family Medicine Physician in Eastchester, NY
• Providers in Eastchester, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.