Healthcare Provider Details

I. General information

NPI: 1215384862
Provider Name (Legal Business Name): SUMMIT OAKS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PROSPECT ST
SUMMIT NJ
07901-2530
US

IV. Provider business mailing address

19 PROSPECT ST
SUMMIT NJ
07901-2530
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-7000
  • Fax:
Mailing address:
  • Phone: 908-522-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number25MA07705500
License Number StateNJ

VIII. Authorized Official

Name: EVANGELOS CHRISTODOULOU
Title or Position: PHYSICIAN
Credential: MD
Phone: 908-522-7000