Healthcare Provider Details

I. General information

NPI: 1679638456
Provider Name (Legal Business Name): WALK WELL SUMMIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SPRINGFIELD AVE
SUMMIT NJ
07901-2603
US

IV. Provider business mailing address

413 SPRINGFIELD AVE WALKWELL SUMMIT, LLC
SUMMIT NJ
07901-2603
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-7979
  • Fax: 908-273-7617
Mailing address:
  • Phone: 908-273-7979
  • Fax: 908-273-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number335E00000X
License Number StateNJ

VIII. Authorized Official

Name: MR. PETER M. ROONEY
Title or Position: OWNER
Credential: C.PED
Phone: 908-766-4737