MEDICARE: JILL LAUREANO-SURBER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	271910	NY

General Provider Information

NPI Number	:	1437443132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL LAUREANO-SURBER DO

Provider Business Mailing Address
First Line	:	20053 SUMMIT VIEW BLVD STE 1
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2170
Country	:	US
Telephone Number	:	315-755-2560
Fax Number	:	315-755-2597

Provider Business Practice Location Address
First Line	:	20053 SUMMIT VIEW BLVD STE 1
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2170
Country	:	US
Telephone Number	:	315-755-2560
Fax Number	:	315-755-2597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	01/24/2024

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