Organization
MONTCLAIR BREAST CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE L HERNANDEZ (BILLING MANAGER)
(973) 744-0604
Entity
Organization
Contact information
Practice address
37 NO FULLERTON AVENUE, MONTCLAIR BREAST CENTER PC, MONTCLAIR, NJ 07042-3426
(973) 509-1818
(973) 509-0708
Mailing address
37 N FULLERTON AVE, MONTCLAIR, NJ 07042-3426
(973) 509-1818
(973) 509-0532
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
NJ
2085U0001X
Diagnostic Ultrasound Physician
—
NJ
208600000X
Surgery Physician
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126219
FDA RADIOLOGY
NJ
01
—
23317
FDA MRI
NJ
Enumeration date
05/26/2006
Last updated
07/09/2026
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