Provider Demographics
NPI:1750720348
Name:SUMMIT MEDICINE AND WELLNESS
Entity type:Organization
Organization Name:SUMMIT MEDICINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUDARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-789-0777
Mailing Address - Street 1:1450 PARKSIDE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2948
Mailing Address - Country:US
Mailing Address - Phone:609-789-0777
Mailing Address - Fax:609-789-0776
Practice Address - Street 1:1450 PARKSIDE AVE STE 4
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2948
Practice Address - Country:US
Practice Address - Phone:609-789-0777
Practice Address - Fax:609-789-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08594900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty