Healthcare Provider Details

I. General information

NPI: 1982641890
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD SUMMIT MEDICAL GROUP
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

1 DIAMOND HILL RD SUMMIT MEDICAL GROUP
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-8872
  • Fax: 908-673-7382
Mailing address:
  • Phone: 908-277-8872
  • Fax: 908-673-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SWAHILI HENRY
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 908-988-0428