Healthcare Provider Details

I. General information

NPI: 1043930555
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 101
HACKENSACK NJ
07601-3244
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 551-999-6433
  • Fax:
Mailing address:
  • Phone: 908-588-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PETER T SAUNDERS
Title or Position: SENIOR VP
Credential:
Phone: 908-588-3930