MEDICARE: SUMMIT AT NEWTON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	2000534	NJ

General Provider Information

NPI Number	:	1629468004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT AT NEWTON, LLC

Provider Business Mailing Address
First Line	:	256 COLUMBIA TPKE
Second Line	:	#100N
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 SPRING ST
Second Line	:	SUITE 101
City	:	NEWTON
State	:	NJ
Zip	:	07860-2080
Country	:	US
Telephone Number	:	609-651-4001
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	THOMAS ALLEN
Credential	:
Telephone Number	:	609-651-4001

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/29/2015

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