Montclair Hospital LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Montclair, NJ
NPI 1265686182 · NPPES record last updated Jun 11, 2013
Key facts
- NPI
- 1265686182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- MONTCLAIR HOSPITAL LLC
- Practice address
- 1 Bay Ave
Montclair, NJ 07042-4837 - Phone
- (973) 429-6451
- NPI assigned
- Nov 5, 2008
- Organization subpart
- No
Authorized official
- Name
- Joe Johnson
- Title
- Vice President
- Phone
- (866) 465-9222
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 6
Member organizations 1
Practitioners 22
-
Kevin James Berg, MD
-
Shereen Dahab, DO
-
Preethi S George, MD
-
Roveena Noeline Goveas, M.D.
-
Michelle L Harney, L.C.S.W.
-
Edward Kosoy, M.D.
-
Young Ju Lee, MD
-
Stephanie Mora, LCSW
-
Nancy Anne Osgoodby, M.S.W.
-
Edward Petrarca, LCSW
-
Everett Schlam, MD
-
Stephen Schram, LSW
-
Isaac K Soliman, M.D.
-
Jennifer Stuart, LCSW
-
Carly Thompson, LCSW
-
Kaitlyn M Valente, LCSW
-
Eniola Teju Ayeni, D.O.
-
Gina Marie Baird, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070814000753 | NJ | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 7810092814 | Practice locations: Montclair, NJ |
National Provider Directory
- Tax ID family
- Mountainside Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NJ | Yes |
Addresses
Primary practice location
1 Bay Ave
Montclair, NJ 07042-4837
Mailing address
1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0139564 | Medicaid | NJ |
Other names
- ESRD Facility
Other providers in Montclair, NJ
- Montclair Emergency Physicians LLC
- Montclair Endocrine Associates
- Montclair Family Eyecare
- Montclair Foot and Ankle
- Montclair Hospital LLC
- Montclair Hospital LLC
- Montclair Hospital LLC
- Montclair Hospital LLC
- Montclair Hospital LLC
- Montclair Hospital LLC
All providers in Montclair, NJ · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.