Provider Demographics
NPI:1174521140
Name:SULLIVAN, BRENDAN P (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:P
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CLIFTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3642
Mailing Address - Country:US
Mailing Address - Phone:973-777-3286
Mailing Address - Fax:973-777-0435
Practice Address - Street 1:1135 CLIFTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3642
Practice Address - Country:US
Practice Address - Phone:973-777-3286
Practice Address - Fax:973-777-0435
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072777207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI03869Medicare UPIN
NJ076888Medicare ID - Type Unspecified