Provider Demographics
NPI:1437443132
Name:LAUREANO-SURBER, JILL (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LAUREANO-SURBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20053 SUMMIT VIEW BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2170
Mailing Address - Country:US
Mailing Address - Phone:315-755-2560
Mailing Address - Fax:315-755-2597
Practice Address - Street 1:20053 SUMMIT VIEW BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2170
Practice Address - Country:US
Practice Address - Phone:315-755-2560
Practice Address - Fax:315-755-2597
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine