Provider Demographics
NPI:1285729806
Name:SUMMIT CARDIOLOGY, LLC
Entity type:Organization
Organization Name:SUMMIT CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-273-1999
Mailing Address - Street 1:ONE SPRINGFIELD AVE. STE. 2A
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4055
Mailing Address - Country:US
Mailing Address - Phone:908-273-1999
Mailing Address - Fax:908-273-1332
Practice Address - Street 1:ONE SPRINGFIELD AVE. STE. 2A
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-273-1999
Practice Address - Fax:908-273-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDA9581OtherRAILROAD MEDICARE
NJ0094838Medicaid
NJDA9581OtherRAILROAD MEDICARE