Healthcare Provider Details

I. General information

NPI: 1386772499
Provider Name (Legal Business Name): SUMMIT PSYCHIATRIC & COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MILLBURN AVENUE STE 5
SPRINGFIELD NJ
07081-1039
US

IV. Provider business mailing address

28 MILLBURN AVENUE STE 5
SPRINGFIELD NJ
07081-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-218-1770
  • Fax: 973-376-7726
Mailing address:
  • Phone: 973-218-1770
  • Fax: 973-376-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA45933
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID G. MILLER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 973-218-1770