Provider Demographics
NPI:1972583540
Name:SURREY, CHRISTINE M (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:SURREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:BUDD-SKAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1040 KINGS HWY N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1908
Mailing Address - Country:US
Mailing Address - Phone:856-414-1155
Mailing Address - Fax:856-414-1313
Practice Address - Street 1:1040 KINGS HWY N
Practice Address - Street 2:SUITE 100
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1908
Practice Address - Country:US
Practice Address - Phone:856-414-1155
Practice Address - Fax:856-414-1313
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07131500207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8948208Medicaid
NJ058245CKPMedicare ID - Type Unspecified
NJ8948208Medicaid