1841245628 NPI number — MONTCLAIR ANESTHESIA ASSOCIATES, P.C.

Table of content: (NPI 1841245628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841245628 NPI number — MONTCLAIR ANESTHESIA ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTCLAIR ANESTHESIA ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841245628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07193-5088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-720-1664
Provider Business Mailing Address Fax Number:
207-753-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BAY AVE
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-429-6930
Provider Business Practice Location Address Fax Number:
973-364-1757
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTZ
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER VP
Authorized Official Telephone Number:
973-429-6250

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6723004 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com