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Summit Medical Group PA

Organization Active NPI Durable Medical Equipment & Medical Supplies · Fair Lawn, NJ

NPI 1194537571 · NPPES record last updated Jan 23, 2025

Key facts

NPI
1194537571
Entity type
Organization (NPI type 2)
Primary specialty
Durable Medical Equipment & Medical Supplies 332B00000X
Legal business name
SUMMIT MEDICAL GROUP PA
Practice address
17-17 Route 208
Fair Lawn, NJ 07410-2820
Phone
(201) 625-1560
NPI assigned
Jan 23, 2025
Organization subpart
Yes
Parent organization (as reported)
SUMMIT MEDICAL GROUP PA

Authorized official

Name
Swahili Henry
Title
Director of Provider Enrollments
Phone
(212) 913-0828

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 1,204

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,204

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2208009Summit Medical Group PA
17-17 Route 208, Fair Lawn, NJ 07410		Certificate of waiverJan 3, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NJ

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250429002189 NJ DME Supplier - Physician - Orthopedic/Orthopedic Surgery
DME Supplier - Physician - Podiatry
DME Supplier - Physician - Physical and Rehabilitation		 5395642276 Practice locations: Fair Lawn, NJ

National Provider Directory

Tax ID family
Summit Medial Group PA (84 organizations share this tax ID)
Part of
Summit Medial Group PA

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Yes

Addresses

Primary practice location

17-17 Route 208
Fair Lawn, NJ 07410-2820

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 588-3635

Other providers in Fair Lawn, NJ

All providers in Fair Lawn, NJ · Durable Medical Equipment & Medical Supplies in New Jersey

Sources for this page

Verify at the official NPI Registry.