Organization
MONTCLAIR HOSPITAL LLC
Active
Parent organization
MONTCLAIR HOSPITAL LLC
Other names
Mountainside Family Practice Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
MONTCLAIR HOSPITAL LLC
Authorized official
JOE JOHNSON (VICE PRESIDENT)
(866) 465-9222
Entity
Organization
Contact information
Practice address
799 BLOOMFIELD AVE, SUITE 201, VERONA, NJ 07044-1367
(973) 746-7050
(973) 857-2831
Mailing address
799 BLOOMFIELD AVE, SUITE 201, VERONA, NJ 07044
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
10766
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10766
STATE LICENSE NUMBER
NJ
Enumeration date
09/03/2008
Last updated
06/11/2013
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