1982788451 NPI number — DR. STUART JOSEPH SURKOSKY DC

Table of content: DR. STUART JOSEPH SURKOSKY DC (NPI 1982788451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982788451 NPI number — DR. STUART JOSEPH SURKOSKY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SURKOSKY
Provider First Name:
STUART
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982788451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
837 EVANS CITY RD
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
RENFREW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-789-9797
Provider Business Mailing Address Fax Number:
724-789-9910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 EVANS CITY RD
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
RENFREW
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-789-9797
Provider Business Practice Location Address Fax Number:
724-789-9910
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC005245 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: AJ005245 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 448263 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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