Jeffrey Evan Superdock, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

676260 Issued in NY

Practice address

7 Sylvan Rd
Smithtown, NY 11787-4926

Phone

(631) 235-4068

NPI assigned

Apr 9, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1902369754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SYLVAN RD",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874926",
            "telephone_number": "631-235-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 SYLVAN RD",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874926",
            "telephone_number": "631-235-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERDOCK",
        "first_name": "JEFFREY",
        "middle_name": "EVAN",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "676260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Sung-Monahan, RPH
• Sunrise Psychology, PLLC
• Sunrise Smithtown Al LLC
• Sunshine Therapy LCSW PC
• McKenzie Suntzenich, PHARMD
• Superio Jao MD PC
• Renee Suriano
• Sherry K Sussman, M.D.
• Selena Sutter-Reizovic, PT
• Julia Sverdlova, M.D.

• Registered Nurse in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.