=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366237877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT MEDICAL GROUP PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 COMMONS WAY
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-685-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DIAMOND HILL RD
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-588-3635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
-----------------------------------------------------
Name | SWAHILI HENRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-913-0828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------