Provider Demographics
NPI:1497476022
Name:SUMMIT MEDICAL GROUP PA
Entity Type:Organization
Organization Name:SUMMIT MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEBENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-790-6567
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-588-3635
Mailing Address - Fax:
Practice Address - Street 1:20 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1939
Practice Address - Country:US
Practice Address - Phone:201-351-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT MEDICAL GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies