Provider Demographics
NPI:1558690446
Name:165 SUMMIT INTERNAL MEDICINE CLINIC PA
Entity Type:Organization
Organization Name:165 SUMMIT INTERNAL MEDICINE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARET
Authorized Official - Middle Name:YEGISE
Authorized Official - Last Name:KAHYAOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-488-5892
Mailing Address - Street 1:165 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1311
Mailing Address - Country:US
Mailing Address - Phone:201-488-5892
Mailing Address - Fax:201-488-0022
Practice Address - Street 1:165 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1311
Practice Address - Country:US
Practice Address - Phone:201-488-5892
Practice Address - Fax:201-488-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61265NJ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG58358Medicare UPIN