Bronx Borough Medical Practice PC
NPI 1124590641ActiveOrganization· Physical Medicine & Rehabilitation, Pain Medicine· Bronx, NY
Physical Medicine & Rehabilitation, Pain Medicine in Bronx, New York, registered in NPPES in December 2018. The authorized official on file is Mack Lee Sullivan, Owner.
Overview
| NPI | 1124590641 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 21, 2018 |
| Last updated in NPPES | Dec 21, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Medicine & Rehabilitation, Pain Medicine Primary | 2081P2900X | — | — |
| Internal Medicine, Sports Medicine | 207RS0010X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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