Provider Demographics
NPI:1780934265
Name:SURDYNSKI, JOSEPH NORMAN (IDC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:NORMAN
Last Name:SURDYNSKI
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16611 S 15TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-0772
Mailing Address - Country:US
Mailing Address - Phone:480-516-4607
Mailing Address - Fax:
Practice Address - Street 1:16611 S 15TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85045-0772
Practice Address - Country:US
Practice Address - Phone:480-516-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
8403OtherSOIDC