Provider Demographics
NPI:1811009137
Name:SUMMIT BREAST CARE, LLC
Entity Type:Organization
Organization Name:SUMMIT BREAST CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-670-4244
Mailing Address - Street 1:98 FORD RD
Mailing Address - Street 2:SUITE 3-H
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1356
Mailing Address - Country:US
Mailing Address - Phone:973-625-3366
Mailing Address - Fax:973-625-0349
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-729-6517
Practice Address - Fax:973-729-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04336800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8767700Medicaid
NJ8767700Medicaid