Provider Demographics
NPI:1962187229
Name:SUMMITT, KIMBERLY ANN (L AC AND CPHT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SUMMITT
Suffix:
Gender:F
Credentials:L AC AND CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1420
Mailing Address - Country:US
Mailing Address - Phone:805-698-9889
Mailing Address - Fax:
Practice Address - Street 1:7 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1420
Practice Address - Country:US
Practice Address - Phone:805-698-9889
Practice Address - Fax:973-366-5105
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00021000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty