Provider Demographics
NPI:1659517464
Name:SUMMIT OAKS HOSPITAL, INC
Entity Type:Organization
Organization Name:SUMMIT OAKS HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-277-9118
Mailing Address - Street 1:19 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2530
Mailing Address - Country:US
Mailing Address - Phone:908-277-9118
Mailing Address - Fax:908-522-7020
Practice Address - Street 1:19 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2530
Practice Address - Country:US
Practice Address - Phone:908-277-9118
Practice Address - Fax:908-522-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087637Medicaid
NJ0087637Medicaid