Healthcare Provider Details

I. General information

NPI: 1225079122
Provider Name (Legal Business Name): AMY SURMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 DARDESS DRIVE
CHATHAM NY
12037
US

IV. Provider business mailing address

P O BOX 2000
HUDSON NY
12534
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-6650
  • Fax: 518-392-4173
Mailing address:
  • Phone: 518-828-8363
  • Fax: 518-697-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: