NPIMap

Organization Active NPI

Montclair Hospital LLC

Doing business as Montclair Multi Speciality Health Center

  • Specialist
  • Montclair, NJ
National Provider Identifier
1093095184
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MONTCLAIR HOSPITAL LLC
Doing business as
Montclair Multi Speciality Health Center
Practice address
1 Bay Ave
Montclair, NJ 07042-4837
Phone
(973) 429-6002
NPI assigned
Aug 22, 2011
Last updated
Nov 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Joe Johnson
Title
Officer
Phone
(866) 465-9222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1 Bay Ave
Montclair, NJ 07042-4837

Mailing address

2400 Dallas Pkwy
Suite 450
Plano, TX 75093-4370

Other names 1

  • Montclair Multi Speciality Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140813000538 NJ Part B Supplier - Hospital Department(S) 7810092814 Receives reassigned benefits from 6 practitioners
Practice locations: Montclair, NJ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2400 Dallas Pkwy
Ste 450
Plano, TX 75093

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1093095184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 DALLAS PKWY",
            "address_2": "SUITE 450",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "973-429-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-22",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "866-465-9222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montclair Multi Speciality Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.