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STANFORD N. SULLUM MD PLLC
NPI 1417227562
Obstetrics & Gynecology - Gynecology in New York, NY

Active since January 06, 2012CLIA 33D0688346 · Microscopy
1136 5TH AVE, 1B, NEW YORK, NY 10128(212) 876-4630(212) 876-3478 Get Directions Write a Review

NPPES record last updated: January 6, 2012. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Stanford N. Sullum Md Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STANFORD N. SULLUM MD PLLC (NPI 1417227562) is a healthcare organization registered as a gynecology in New York, New York and active in the NPI registry since January 2012. The organization holds a CLIA Microscopy certificate valid through August 31, 2026 and lists Stanford N Sullum, Owner, as its authorized official.

NPPES Registry Identity

NPI1417227562
Entity TypeOrganization
Primary Taxonomy207VG0400X
Legal Business NameSTANFORD N. SULLUM MD PLLC
Location Address1136 5TH AVE, 1BNew York, NY 10128-0122
Mailing Address1136 5th Ave, 1bNew York, NY 10128-0122 · (212) 876-4630 · Fax (212) 876-3478
Phone(212) 876-4630
Fax(212) 876-3478
Organization SubpartNo
Authorized OfficialStanford N SullumOwner · (212) 876-4630
Enumeration DateJanuary 6, 2012
✔ NPI 1417227562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & Gynecology · GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207VG0400X
Definition
A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee
1136 5TH AVE, New York, NY 10128
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 33D0688346

Stanford N Sullum MD · New York, NY
Active · expires Aug 31, 2026
CLIA Number33D0688346
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorS N Sullum MD
Laboratory Phone(212) 876-4630
Laboratory LocationStanford N Sullum MD1136 Fifth Ave, New York, NY 10128
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. STEVEN ROBERT GROSSMAN DDS
Dentist (Pediatric Dentistry)
1136 5TH AVE, APT 10
NEW YORK, NY 10128
New York County (212) 876-7408
JAMAL RAHAMAN GYN ONCOLOGIST PLLC
Obstetrics & Gynecology (Gynecologic Oncology)
1136 5TH AVE, SUITE 1B
NEW YORK, NY 10128
New York County (212) 427-1415
MARC L PATENAUDE DDS
Dentist
1136 5TH AVE
NEW YORK, NY 10128
New York County (212) 876-7408
DR. RAYMOND Z SANDLER M.D.
Obstetrics & Gynecology
1136 5TH AVE
NEW YORK, NY 10128
New York County (212) 996-2300
DR. STANFORD NORMAN SULLUM MD
Obstetrics & Gynecology
1136 5TH AVE, 1B
NEW YORK, NY 10128
New York County (212) 876-4630
DR. JAMAL RAHAMAN M.D.
Obstetrics & Gynecology (Gynecologic Oncology)
1136 5TH AVE, SUITE 1B
NEW YORK, NY 10128
New York County (212) 427-1415

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stanford N. Sullum MD PLLC's NPI number?

The NPI number for Stanford N. Sullum MD PLLC is 1417227562. It was assigned to this organization in the NPPES registry on January 6, 2012.

Where is Stanford N. Sullum MD PLLC located?

Stanford N. Sullum MD PLLC is located at 1136 5th Ave 1B, New York, NY 10128. The listed phone number is (212) 876-4630.

What is Stanford N. Sullum MD PLLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Gynecology, with taxonomy code 207VG0400X.

Does Stanford N. Sullum MD PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 33D0688346) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Stanford N. Sullum MD PLLC was last updated on January 6, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.