Provider Demographics
NPI:1043379142
Name:SUMMIT DIAGNOSTIC AND PHYSICAL MEDICINE PC
Entity Type:Organization
Organization Name:SUMMIT DIAGNOSTIC AND PHYSICAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-653-5031
Mailing Address - Street 1:559 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2701
Mailing Address - Country:US
Mailing Address - Phone:201-653-5031
Mailing Address - Fax:201-653-4677
Practice Address - Street 1:559 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2701
Practice Address - Country:US
Practice Address - Phone:201-653-5031
Practice Address - Fax:201-653-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty