Provider Demographics
NPI:1376698720
Name:SUMMITEK, INC
Entity Type:Organization
Organization Name:SUMMITEK, INC
Other - Org Name:SUMMITEK MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOON
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-747-6363
Mailing Address - Street 1:131-31 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2539
Mailing Address - Country:US
Mailing Address - Phone:718-747-6363
Mailing Address - Fax:718-747-6361
Practice Address - Street 1:131-31 31ST AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11354-2539
Practice Address - Country:US
Practice Address - Phone:718-747-6363
Practice Address - Fax:718-747-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4938610001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4938610001Medicare ID - Type Unspecified