1972583540 NPI number — CHRISTINE M SURREY D.O.

Table of content: CHRISTINE M SURREY D.O. (NPI 1972583540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972583540 NPI number — CHRISTINE M SURREY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SURREY
Provider First Name:
CHRISTINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUDD-SKAND
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972583540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 KINGS HWY N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-1908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-414-1155
Provider Business Mailing Address Fax Number:
856-414-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 KINGS HWY N
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-414-1155
Provider Business Practice Location Address Fax Number:
856-414-1313
Provider Enumeration Date:
01/19/2006

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: 207R00000X , with the licence number:  MB07131500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: MB07131500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8948208 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com