Mack Lee Sullivan MD Functional Medicine PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MACK LEE SULLIVAN MD FUNCTIONAL MEDICINE PC

Practice address

369 White Plains Rd
Eastchester, NY 10709-2805

Phone

(914) 395-3691

NPI assigned

May 28, 2026

Last updated

May 28, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mack Lee Sullivan, MDNPI 1881616068

Title

Medical Director

Phone

(914) 395-3691

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mack Lee Sullivan, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Eastchester, NY
  • NPI 1881616068
  Authorized official Same address or phone

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

{
    "created_epoch": "1779926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779926400000",
    "number": "1962333633",
    "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": "MACK LEE SULLIVAN MD FUNCTIONAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-28",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Liebowitz, MD
• Alfred Michael Lisanti, LAC.
• Xingwu Lu
• Linda Luciano
• Victoria Lusk, PSYD
• Mack Lee Sullivan MD Ms Urgent Medical Care of Eastchester, PLLC (Eastchester Urgent Care)
• Tania Nicole Maggiolo
• Dina Marie Manginelli
• Nancy Neff Manister, DNS, FNP-BC
• Virginia Angela Mannello, PHARMD

• Primary Care Clinic/Center in Eastchester, NY
• Providers in Eastchester, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.