Provider Demographics
NPI:1659527752
Name:SURDOW, LORIANN (RN)
Entity Type:Individual
Prefix:
First Name:LORIANN
Middle Name:
Last Name:SURDOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MIDDLE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2633
Mailing Address - Country:US
Mailing Address - Phone:631-475-7534
Mailing Address - Fax:
Practice Address - Street 1:49 MIDDLE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2633
Practice Address - Country:US
Practice Address - Phone:631-475-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602917-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY602917-1Medicaid