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General NPI Number Information
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NPI Number | 1679638456
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Entity Type | Organization
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Legal Business Name | WALK WELL SUMMIT LLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 413 SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-2603
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Country | US
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Telephone | 908-273-7979
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Fax | 908-273-7617
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Provider Business Mailing Address
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Address Line | 413 SPRINGFIELD AVE WALKWELL SUMMIT, LLC
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City | SUMMIT
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State | NJ
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Zip | 07901-2603
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Country | US
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Telephone | 908-273-7979
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Fax | 908-273-7617
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Authorized Official
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Title or Position | OWNER
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Name | MR. PETER M. ROONEY
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Credential | C.PED
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Telephone | 908-766-4737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 335E00000X
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State | NJ
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