Active NPI
George John Sullivan III
- Rehabilitation Psychologist
- Riverhead, NY
National Provider Identifier
1992384200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- Practice address
- 208 Roanoke Ave
Riverhead, NY 11901-2706 - Phone
- (631) 357-0173
- NPI assigned
- Apr 5, 2021
- 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 |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | Primary |
Addresses
Primary practice location
208 Roanoke Ave
Riverhead, NY 11901-2706
Mailing address
25 Soundway Dr
Rocky Point, NY 11778-9001
Phone (631) 741-4988
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K6043576401 | Other | NY | EMBLEM HEALTH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Riverhead | Health Information Exchange (HIE) | Family Service League Inc |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Service League, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Huntington, NY
- NPI 1528093242
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617580800000",
"number": "1992384200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 SOUNDWAY DR",
"city": "ROCKY POINT",
"state": "NY",
"postal_code": "117789001",
"telephone_number": "631-741-4988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 ROANOKE AVE",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012706",
"telephone_number": "631-357-0173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "GEORGE",
"middle_name": "JOHN",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-05",
"last_updated": "2021-04-05",
"certification_date": "2021-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMBLEM HEALTH",
"identifier": "K6043576401",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Riverhead",
"affiliation": "Y",
"affiliationName": "Family Service League Inc",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "208 Roanoke Ave",
"city": "Riverhead",
"state": "NY",
"country_code": "US",
"postal_code": "119012706",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.