Jack Surgenor
Dietitian, Registered in Durham, Connecticut
1093677650- Practice location
- 20 Laurel Trl, Durham, CT 06422-3400
- Phone
- 203-464-9095
- Fax
- —
- Last updated
- December 2, 2025
Jack Surgenor is a Dietitian, Registered based in Durham, CT. Jack Surgenor practices in Durham, CT. The NPI Number for Jack Surgenor is 1093677650 and holds a License No. 3048 (CT). The current practice location address for Jack Surgenor is 20 Laurel Trl, Durham, CT 06422-3400 and can be reached out via phone at 203-464-9095.
Provider Profile Details
- NPI Number
- 1093677650
- Provider Name
- Jack Surgenor
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 20 Laurel Trl, Durham, CT 06422-3400
- Phone Number
- 203-464-9095
- Primary Taxonomy
- Dietitian, Registered · 133V00000X
- Sole Proprietor
- No
- Provider Enumeration Date
- December 2, 2025
- Last Update Date
- December 2, 2025
- Certification Date
- December 2, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 20 Laurel Trl
Durham, CT 06422-3400 - City
- Durham
- State
- Connecticut
- Zip
- 06422-3400
- Phone Number
- 203-464-9095
Provider Business Mailing Address Details
- Address
- 20 Laurel Trl
Durham, CT 06422-3400 - City
- Durham
- State
- CT
- Zip
- 06422-3400
- Phone Number
- 203-464-9095
License Information
- License Number
- 3048
- License State
- CT
- Taxonomy
- Dietitian, Registered · 133V00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Jack Surgenor?
The NPI number of Jack Surgenor is 1093677650. It was assigned on December 2, 2025 and is currently active in the NPPES registry.
What is the specialty of Jack Surgenor?
Jack Surgenor is registered under the primary taxonomy Dietitian, Registered (code 133V00000X), licensed in CT under license number 3048.
Where does Jack Surgenor practice?
The practice location is 20 Laurel Trl, Durham, CT 06422-3400. The office can be reached at 203-464-9095 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1093677650 directly on the NPPES registry website.