Provider Demographics
NPI:1609042761
Name:SUMMIT REHABILITATION MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SUMMIT REHABILITATION MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARANJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BASRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-781-7882
Mailing Address - Street 1:729 SUNRISE AVENUE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4542
Mailing Address - Country:US
Mailing Address - Phone:916-781-7882
Mailing Address - Fax:916-781-3787
Practice Address - Street 1:729 SUNRISE AVENUE
Practice Address - Street 2:SUITE 602
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-781-7882
Practice Address - Fax:916-781-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83769305R00000X
CAG23317305R00000X
CAA73010305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730100Medicare PIN
CA00G233171Medicare PIN
CA00A837691Medicare PIN