Provider Demographics
NPI:1386772499
Name:SUMMIT PSYCHIATRIC & COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:SUMMIT PSYCHIATRIC & COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-218-1770
Mailing Address - Street 1:28 MILLBURN AVENUE STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1023
Mailing Address - Country:US
Mailing Address - Phone:973-218-1770
Mailing Address - Fax:973-376-7726
Practice Address - Street 1:28 MILLBURN AVENUE STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1039
Practice Address - Country:US
Practice Address - Phone:973-218-1770
Practice Address - Fax:973-376-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA459332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ630428Medicare PIN