Provider Demographics
NPI:1982962346
Name:SURNIAK-GRUENLER, JENNIFER LYNN (MED, LDT-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SURNIAK-GRUENLER
Suffix:
Gender:F
Credentials:MED, LDT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 POST BROOK RD S
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-4518
Mailing Address - Country:US
Mailing Address - Phone:973-513-3130
Mailing Address - Fax:
Practice Address - Street 1:27 POST BROOK RD S
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-4518
Practice Address - Country:US
Practice Address - Phone:973-513-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400478961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist