MEDICARE: DR. SARA JANE SKURNICK DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22D10577400	NJ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	040614-1	NY

General Provider Information

NPI Number	:	1184712853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA JANE SKURNICK DMD

Provider Business Mailing Address
First Line	:	2533 86 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	718-372-0009
Fax Number	:	718-372-0010

Provider Business Practice Location Address
First Line	:	195 BRIDGETOWN STREET
Second Line	:	STATEN ISLAND PEDIATRIC DENTAL
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6006
Country	:	US
Telephone Number	:	718-761-7316
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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