MEDICARE: DARLINE SURPRIS

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	163WS0200X	School Registered Nurse	627839	NY

General Provider Information

NPI Number	:	1033419064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLINE SURPRIS

Provider Business Mailing Address
First Line	:	655 E 94TH ST
Second Line	:	#2F
City	:	BROOKLYN
State	:	NY
Zip	:	11236-1105
Country	:	US
Telephone Number	:	347-579-5834
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 EAST 94 STREET
Second Line	:	#2F
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2104
Country	:	US
Telephone Number	:	347-579-5834
Fax Number	:

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	03/26/2014

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Directions to “ DARLINE SURPRIS ” Practice Location

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