# MONTCLAIR STATE UNIVERSITY OCCUPATIONAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MONTCLAIR STATE UNIVERSITY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376144790
- **Legal business name:** MONTCLAIR STATE UNIVERSITY
- **Authorized official:** DR. GREGG SUMMERVILLE MD (OCCUPATIONAL HEALTH PHYSICIAN)
- **Authorized official phone:** (973) 655-5014

## Contact information

- **Practice address:** 1 NORMAL AVENUE, BLANTON HALL, MONTCLAIR, NJ 07043-1624
- **Practice address phone:** (973) 655-5014
- **Mailing address:** 1 NORMAL AVENUE, BLANTON HALL, MONTCLAIR, NJ 07043-1624
- **Mailing address phone:** (973) 655-5014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2020
- **Last updated:** 11/03/2020