Provider Demographics
NPI:1154875755
Name:SUMMIT CLINICAL GROUP LLC
Entity type:Organization
Organization Name:SUMMIT CLINICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:H
Authorized Official - Last Name:DITCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-382-0012
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:#167
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:#167
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1527
Practice Address - Country:US
Practice Address - Phone:718-382-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service