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General NPI Number Information
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NPI Number | 1992112387
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Entity Type | Organization
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Legal Business Name | JILL M LAUREANO SURBER DO PC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 20053 SUMMIT VIEW BLVD STE 1
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City | WATERTOWN
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State | NY
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Zip | 13601-2170
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Country | US
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Telephone | 315-755-2560
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Fax | 315-755-2597
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Provider Business Mailing Address
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Address Line | 20053 SUMMIT VIEW BLVD STE 1
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City | WATERTOWN
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State | NY
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Zip | 13601-2170
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Country | US
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Telephone | 315-755-2560
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Fax | 315-755-2597
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Authorized Official
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Title or Position | OWNER
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Name | DR. JILL LAUREANO-SURBER
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Credential | DO
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Telephone | 315-755-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 271910
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License Number State | NY
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