Healthcare Provider Details

I. General information

NPI: 1699165084
Provider Name (Legal Business Name): SUMMIT AT FLORHAM PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 COLUMBIA TPKE 100N
FLORHAM PARK NJ
07932-1209
US

IV. Provider business mailing address

256 COLUMBIA TPKE 100N
FLORHAM PARK NJ
07932-1209
US

V. Phone/Fax

Practice location:
  • Phone: 973-593-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000536
License Number StateNJ

VIII. Authorized Official

Name: THOMAS ALLEN
Title or Position: MBR
Credential:
Phone: 609-651-4001