NPIMap

Organization Active NPI

Summit Medical Group PA

  • Clinical Medical Laboratory
  • Woodland Park, NJ
National Provider Identifier
1568112910
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SUMMIT MEDICAL GROUP PA
Practice address
1225 McBride Ave
Woodland Park, NJ 07424-3812
Phone
(908) 273-4300
NPI assigned
Mar 28, 2022
Organization subpart
Yes
Parent organization
SUMMIT MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey D Lebenger
Title
Ceo
Phone
(908) 790-6567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1225 McBride Ave
Woodland Park, NJ 07424-3812

Mailing address

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0116144Summit Health-1225 McBride Avenue, Woodland Park, NJ 07424AccreditationSep 18, 2027
31D0715764Medical Associates of Englewood, PC1225 McBride Avenue, Woodland Park, NJ 07424Certificate of waiverMay 12, 2027
31D2079912Medical Associates of Englewood, PC1225 McBride Ave, Suite 223, Woodland Park, NJ 07424Certificate of waiverJun 25, 2028
31D2290539Medical Associates of Englewood, PC1225 McBride Ave, Woodland Park, NJ 07424Certificate of waiverSep 26, 2027
31D2308955Hva Medical Group1225 McBride Ave, Woodland Park, NJ 07424RegistrationAug 6, 2026
31D2332559Medical Associates of Englewood, PC1225 McBride Ave, Woodland Park, NJ 07424Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Summit Medial Group PA84 organizations share this tax ID, including this one
Part of
Summit Medial Group PA

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1568112910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "908-588-3635",
            "fax_number": "908-934-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MCBRIDE AVE",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074243812",
            "telephone_number": "908-273-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT MEDICAL GROUP PA",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "LEBENGER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "908-790-6567"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.