Provider Demographics
NPI:1215239462
Name:SUMMIT DIAGNOSTIC AND TREATMENT CENTER,LLC
Entity type:Organization
Organization Name:SUMMIT DIAGNOSTIC AND TREATMENT CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-392-8900
Mailing Address - Street 1:500 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3421
Mailing Address - Country:US
Mailing Address - Phone:201-392-8900
Mailing Address - Fax:201-392-8999
Practice Address - Street 1:500 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3421
Practice Address - Country:US
Practice Address - Phone:201-392-8900
Practice Address - Fax:201-392-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-20
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00685800261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service