NPIMap

Organization Active NPI

Montclair Hospital LLC

Doing business as ESRD Facility

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Montclair, NJ
National Provider Identifier
1265686182
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MONTCLAIR HOSPITAL LLC
Doing business as
ESRD Facility
Practice address
1 Bay Ave
Montclair, NJ 07042-4837
Phone
(973) 429-6451
NPI assigned
Nov 5, 2008
Last updated
Jun 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Authorized official

Name
Joe Johnson
Title
Vice President
Phone
(866) 465-9222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NJ Primary

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 names 1

  • ESRD Facility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070814000753 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 7810092814 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
Tax ID family
Mountainside Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1265686182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "973-429-6000",
            "fax_number": "973-429-6209"
        },
        {
            "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": "973-429-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "866-465-9222"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ESRD Facility",
            "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 Jun 11, 2013; 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.