Provider Demographics
NPI:1538461082
Name:SURCK, LYNDA (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:SURCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TELEPORT DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10311-1006
Mailing Address - Country:US
Mailing Address - Phone:718-273-5500
Mailing Address - Fax:718-273-3232
Practice Address - Street 1:2 TELEPORT DR
Practice Address - Street 2:SUITE 207
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10311-1006
Practice Address - Country:US
Practice Address - Phone:718-273-5500
Practice Address - Fax:718-273-3232
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant