Provider Demographics
NPI:1194947382
Name:SURACH, CRISTINA (ANP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SURACH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:SURACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:413 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2217
Mailing Address - Country:US
Mailing Address - Phone:212-241-0511
Mailing Address - Fax:212-289-5971
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1030
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-0511
Practice Address - Fax:212-289-5971
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303739363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner