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SUMMIT AVENUE MEDICAL PA
NPI 1275531550
Internal Medicine in Hackensack, NJ

Active since July 12, 2005CLIA 31D0695875 · Waiver
5 SUMMIT AVE, STE 1, HACKENSACK, NJ 07601(201) 646-0001(201) 646-9101 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Summit Avenue Medical Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUMMIT AVENUE MEDICAL PA (NPI 1275531550) is a healthcare organization registered as an internal medicine in Hackensack, New Jersey and active in the NPI registry since July 2005. The organization holds a CLIA Waiver certificate valid through March 31, 2028 and lists Sharon B Levont, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1275531550
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSUMMIT AVENUE MEDICAL PA
Location Address5 SUMMIT AVE, STE 1Hackensack, NJ 07601-8503
Mailing Address5 Summit Ave, Ste 1Hackensack, NJ 07601-8503 · (201) 646-0001 · Fax (201) 646-9101
Phone(201) 646-0001
Fax(201) 646-9101
Organization SubpartNo
Authorized OfficialSharon B LevontOffice Manager · (201) 646-0001
Enumeration DateJuly 12, 2005
Last NPPES UpdateJuly 21, 2022
✔ NPI 1275531550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
5 SUMMIT AVE, Hackensack, NJ 07601
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Other Identifiers 3

OtherCD1762Railroad Medicare
Other0127584001Amerihealth
Other2514Aetna Us Healthcare

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Summit Avenue Medical Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Summit Avenue Medical PA, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Adam Goldfarb, MD
Internal Medicine
NPI 1275534174
5 SUMMIT AVE
Hackensack, NJ 07601
(201) 646-0001
✔ PECOS✔ Accepts MedicareSame address
Edward Prins, MD
Internal Medicine
NPI 1619978905
5 SUMMIT AVE
Hackensack, NJ 07601
(201) 646-0001
✔ PECOS✔ Accepts MedicareSame address
Kalpana Cheeti, M.D.
Internal Medicine
NPI 1649352857
15 ANDERSON ST
Hackensack, NJ 07601
(201) 487-3355
✔ PECOS✔ Accepts Medicare0.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D0695875

Summit Ave Medical · Hackensack, NJ
Active · expires Mar 31, 2028
CLIA Number31D0695875
Laboratory TypePhysician Office
Certificate Effective DateApril 1, 2026
Certificate Expiration DateMarch 31, 2028
Laboratory DirectorEdward R. Prins
Laboratory Phone(201) 646-0001
Laboratory LocationSummit Ave Medical5 Summit Ave, Suite 101, Hackensack, NJ 07601
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Summit Avenue Medical PA's NPI number?

The NPI number for Summit Avenue Medical PA is 1275531550. It was assigned to this organization in the NPPES registry on July 12, 2005.

Where is Summit Avenue Medical PA located?

Summit Avenue Medical PA is located at 5 Summit Ave Ste 1, Hackensack, NJ 07601. The listed phone number is (201) 646-0001.

What is Summit Avenue Medical PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Summit Avenue Medical PA enrolled in Medicare?

Yes. Summit Avenue Medical PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Summit Avenue Medical PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Internal Medicine, reassign their Medicare billing to Summit Avenue Medical PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Summit Avenue Medical PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D0695875) is associated with this NPI, valid through March 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Summit Avenue Medical PA was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.