Provider Demographics
NPI:1184712853
Name:SKURNICK, SARA JANE (DMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JANE
Last Name:SKURNICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 86 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-372-0009
Mailing Address - Fax:718-372-0010
Practice Address - Street 1:195 BRIDGETOWN STREET
Practice Address - Street 2:STATEN ISLAND PEDIATRIC DENTAL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6006
Practice Address - Country:US
Practice Address - Phone:718-761-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D105774001223X0400X
NY040614-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics