Provider Demographics
NPI:1336834886
Name:SURGEON, JOHN-TOD HARRISON
Entity Type:Individual
Prefix:
First Name:JOHN-TOD
Middle Name:HARRISON
Last Name:SURGEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 IRVING TER
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3023
Mailing Address - Country:US
Mailing Address - Phone:862-224-4278
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8443
Practice Address - Fax:516-663-8955
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program