Provider Demographics
NPI:1649398793
Name:SUMMIT PODIATRY GROUP, PA
Entity Type:Organization
Organization Name:SUMMIT PODIATRY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLINGTON
Authorized Official - Middle Name:YUNG
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-665-0010
Mailing Address - Street 1:1811 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1041
Mailing Address - Country:US
Mailing Address - Phone:908-665-0010
Mailing Address - Fax:908-665-0510
Practice Address - Street 1:1811 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1041
Practice Address - Country:US
Practice Address - Phone:908-665-0010
Practice Address - Fax:908-665-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00970213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ0790470001Medicare NSC
NJ460997Medicare PIN
NJCB7273Medicare PIN