Active NPI
Andrew Joseph Sullivan Jr., D.D.S.
- Periodontics
- Bayonne, NJ
National Provider Identifier
1861546517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 9314
- Practice address
- 19 W 33Rd St
A
Bayonne, NJ 07002-3916 - Phone
- (201) 437-9098
- Fax
- (201) 436-1595
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 9314 | NJ | Primary |
Addresses
Primary practice location
19 W 33Rd St
A
Bayonne, NJ 07002-3916
Mailing address
25 Montview Ave
Short Hills, NJ 07078-2034
Phone (973) 376-7618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9314 | NJ | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861546517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 MONTVIEW AVE",
"city": "SHORT HILLS",
"state": "NJ",
"postal_code": "070782034",
"telephone_number": "973-376-7618",
"fax_number": "973-376-0073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 W 33RD ST",
"address_2": "A",
"city": "BAYONNE",
"state": "NJ",
"postal_code": "070023916",
"telephone_number": "201-437-9098",
"fax_number": "201-436-1595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NJ",
"license": "9314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayonne, NJ
Sources for this page
- 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.