Organization
MONTCLAIR STATE UNIVERSITY OCCUPATIONAL HEALTH
Active
Parent organization
MONTCLAIR STATE UNIVERSITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
MONTCLAIR STATE UNIVERSITY
Authorized official
DR. GREGG SUMMERVILLE MD (OCCUPATIONAL HEALTH PHYSICIAN)
(973) 655-5014
Entity
Organization
Contact information
Practice address
1 NORMAL AVENUE, BLANTON HALL, MONTCLAIR, NJ 07043-1624
(973) 655-5014
Mailing address
1 NORMAL AVENUE, BLANTON HALL, MONTCLAIR, NJ 07043-1624
(973) 655-5014
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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