Organization
MONTCLAIR MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENITA OGLESBY DO (OWNER)
(973) 592-2733
Entity
Organization
Contact information
Practice address
290 S LIVINGSTON AVE, LIVINGSTON, NJ 07039-3931
(972) 592-2733
Mailing address
290 S LIVINGSTON AVE, LIVINGSTON, NJ 07039-3931
(972) 592-2733
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB08472400
NJ
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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