Provider Demographics
NPI:1417628199
Name:SUMBALY, PAIGE MERCEDES (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MERCEDES
Last Name:SUMBALY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4214
Mailing Address - Country:US
Mailing Address - Phone:732-322-0364
Mailing Address - Fax:
Practice Address - Street 1:7 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4214
Practice Address - Country:US
Practice Address - Phone:732-322-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01202600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics