Healthcare Provider Details

I. General information

NPI: 1376722660
Provider Name (Legal Business Name): SUMMIT HEALTHCARE PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 8TH ST
OLEAN NY
14760
US

IV. Provider business mailing address

401 N 8TH ST
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-5273
  • Fax: 716-375-5270
Mailing address:
  • Phone: 716-375-5273
  • Fax: 716-375-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number005651
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier02705246
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. HEATHER ANNE PIATT
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-375-5273